HomeMy WebLinkAboutDrain Layers Permit 156 Morgan Farms Roa y0�4E1TY3^d4 �h.^.}a� •_�
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TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNO, 4732
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(o rn o r9 co F2)'Ut.O �r l 9 l�
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Pursuant to written application, permission is here 3 ed to t e Licensed Drain Layer
named herein to perform the o k 'ndic ted below at 4
at premises owned by ��C�.� hose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
a
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Zo Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer h eby agrees to all the terms and
conditions set forth in the permit and the reverse sid hereof. Applicant h.4s r eived
Town Permit No. and/or CHD Permit No.
Signed
Licensed 17rain Laye
The above named Drain Layer has a valid lic nse issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
_7
Connection Charge Paid /�2 � Permit Fee: Paid $
Check Number fs 0,z___
Issued by
Tax Office
INSPECTION
Date work started -' �� g 7 Date completed
Sufficient notification received: Yes No
Special Conditions
APP ZZ
Date Inspector