HomeMy WebLinkAboutDrain Layers Permit 166 Natsisky Farm Ro ✓ TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19
Pursuant to written application, permission is hereby granted to the. Licensed Drain Layer
named herein to perform the work indicated below at
�
lt.���. � > C
at premises owned by I L' F t r r» ►C�c1
who de address is
Lav House nrai„ n___.-__ ..- and to
f�
e Drain, Lay Main, Other
F; occupancy or use, with
n � -� '�G" ' s permit: SANITARY SEWAGE ,
Wt der this ( ) INDUSTRIAL
_ Connection will be made with
St "I two (2) copies of separate drawings.
._. '•,�J% l�,'�-'Uric,-�''Y %:('1,�j"'}`--.
Desired Starting Date Estimated Time for Completion
Permit to be issued toG3
the holder of Drain Layer's License No ;
after date of issuance. The undersigned Drain Layer hereby agrees Xtorallhthee tyterms ands
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No. 2. oFr
Signed
Licensed 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 policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid 1 � �.=� Permit Fee: Paid $
Check Number
Issued by
Tax Office G
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: _ Z
nspec or pate