HomeMy WebLinkAboutDrain Layers Permit 201 Natsisky Farm Ro w r TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
y ` 5449
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GSisty , m Rol r'
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Pursuant to written application, permission is hereby ranted to the Licensed Drain, L er
named herein to perform the word in�lica ed a at
at premises owned by �.�� , .; �, �i�� ,. ;E -1 ���' ' whose address is
Lay House Drain, Repair House Drain-, La Main and to
for y , ____ Other
acres.
Family Units, with 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.
-f
I t
SPECIAL CONDITIONS _
Desired Starting Date
Estimated Time for Completion
Permit to be issued to /
the holder of Drain Layer's License No. Z A
Permit will after date of issuance. The undersigned Drain Layer her by agrees xtor all htheyterms and
conditions set forth in the permit and the reverse side thereof, Applicant ha :received
Town Permit No. and/or CHD Permit No. i
Signed.,.- r�c ��- ,�/l _. .,,-
Licensed Dr 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 T of South Windsor:
LEng g Depa m t
Date
Connection Charge Paid
Permit Fee: Paid $ f�, as
Check Number1 ;
j /
Tax Office Issued by
INSPECTION
Date work started - /- �%' Date completed
Sufficient notification received: Yes
Special Conditions No
APPROVED: - ;-¢ /
spector Date