HomeMy WebLinkAboutDrain Layers Permit 15 Natsisky Farm Roa (2) TOWN OF SOUTH WI N DSOR
(7 DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o, 4649
19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform tie work indicated below at
at premises owned by J� A whose address is
�'— r 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
L
Show sketch of proposedrfumish (2) copies of separate drawings.
S-Ir`oet hoe,SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
signed
y ' - .�-
T'' 1-3censed 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 polic i the name of the Town of South Windsor:
r
Engineering Ijepdhfm6nt Date
Connection Charge Paid t" �,j' 5� ? Permit Fee: Paid $ J v l
Check Number nit, S
Issued by oz
Tax Dffise N
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPRUV
L Inspector Date /