HomeMy WebLinkAboutDrain Layers Permit 137 Natsisky Farm Ro • .r H :: '- ii.l''.,:` �r i`N' yt:e .�•'d,t.r:.+,•. `y .v .'fa ,•Y" r i •. a K .
jn a1..
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o. 4723
Pursuant to written Application, permission is ,hereb granted to the Licensed Drain Layer
named herein to perfor4I\the w rk,indicate- -jbel w at L'o
at premises owned by / C{�L, �•f> i 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 (A1; 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 Atme for Co letion
r f
Permit to be issued to
the holder of Drain Layer's License No. 307 ermit 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
Licensed Drain Layer
The above named Drain Layer has a valid license i� t&d by the State of Connecticut and
has filed a satisfactory bond and insurance policy. , the name of the Town of South Windsor:
Engine ng teAp e�ar4t,i Lek t Date
Connection Charge Paid Permit Fee: Paid $ J
Check Number i
,t P1,
- V % / Z Q�Ys-sued by
Tax Office
INSPECTION `
Date work started �— / Z—g 7 Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED•
Inspector pate