HomeMy WebLinkAboutDrain Layers Permit 148 Morgan Farms Roa TOWN OF SOUTH WI N DSOR-
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT AjUo, 4 `ry
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Pursuant to written'-Application, permission is herety granted to the Licensed Drain Layer
named herein to perform t work indica_reed below at /
at premises owned by 0 whose 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.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to / ,�L� /� Cj✓rT
the holder of Drain Layer's License No. Zs 7 7VI 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 sige yhereof. Applicant has ived
Town Permit No. and/or CHD Permit No.
i
Signed
License& Drain Layer
The above named Drain Layer has a valid license/issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
4&322
j ! ) Engineering— Department Date
Connection Charge Paid /lo / Permit Fee: Paid $
i
i�
f Check Number=-' '
Issued by
Tax Office
INSPECTION
Date work started Z s Date completed Z Zr 7
Sufficient notification received: es No
Special Conditions
APPROVED: - 2 2 ,
Ins ctor Date