HomeMy WebLinkAboutDrain Layers Permit 214 Natsisky Farm Ro TOWN OF SOUTU WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLkUTION CONTROL
DRAIN LAYER'S PERMIT Xoo. 5 Q 38
c 1,4 n at -sist<q T't rrn 0 , 19
Pursuant to written application, ermissi P qn is hereby granted to the Licensed Drain
named herein to perform;the work indicated below at Layer
at premises owned by y ,� '
wpose address is
Lay House Drain, Repair House Drain, La Main and to
for y _____------ Other
Family Units, with acres. occupancy or use, with ---
Type of Sewage to be connected under this permit: SANITARY SEWAGE ��WASTES ( ), OR , INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS 71A 7 ' ' '
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. ,� .
Permit wi after date of issuance. The undersign ed Dra n Layer he by agrees torallh the yterms ands
conditions set forth in the permit and the reverse side thereof. ,Applicant has received
Town Permit No. and/or CHD Permit No.
Signed l�
' Licensed Hrain tiayer -%1'(. -- -'—
The above named Drain Layer has a valid license issued by theState of Connecticut and
has filed a satisfactory bond and insurance policy i name of the Town of South Windsor:
Engineering Departmen Date
Connection Charge Paid Permit Fee: Paid $
Check Number /
Issued b
Tax f3f f is e y
INSPECTION
Date work started - `J �7 Date completed
Sufficient notification received: =% 7
Yes No
Special Conditions
i
APPROVED
Inspector`
Date