HomeMy WebLinkAboutDrain Layers Permit 232 Natsisky Farm Ro TOWN OF SOUTH WINDSOR
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DEPARTMENT OF PUBLIC WORKS
/ BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Naf 5065
19 .
Pursuant to written application, permission is hereby granted to the Licen ed ow at Dra n Layer
named herein to perform the work indicated below
at premises owned b f );
Y whose 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 ` "f#C :P k or 4u furnish (2) copi of separate drawing
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SPECIAL CONDITIONS o ?A4)
• Desired Starting Date Estimated Time for Com 1e p tion
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 as received
Town Permit No. and/or CHD .Permit No.
1
Signed G �
icensed ain 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:
Engineering Department Date
Connection Charge Paid 1 JJ Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION �
1 j.:...n
Date work started " Date completed
-
Sufficient notification received: Yes ---- - --
Special Conditions No
APPROVED: �, .�
-=Inspector .� YDate,