HomeMy WebLinkAboutDrain Layers Permit 15 Natsisky Farm Roa (3) TOWN OF SOUTH WINDSOR
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b DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4649
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layerr
named herein to perform the work indicated below at f- 1;`,T",/ ,
at premises owned by '4'-- ---r` -r
whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANI
WASTES OR TARY SEWAGE ( ), INDUSTRLAL
{ ), ( ) Connection will be made with
Show sketch of proposed ork or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS ��`
t
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 4
Permit will expire thirty (30) days
after date of issuance. The undersigne 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.
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Signed y .mott
> G'' :
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 polic i the name of the Town of South Windsor:
Engineering Dep` merit Date
Connection Charge Paid " j'� 5� ;? permit Fee: Paid
' Check Number f,r�
��`, • * . �, � /t F' Issued by ,.�"}5 n
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Tax Office )
INSPECTION
Date work started Date completed C
Sufficient notification received: Yes No
Special Conditions
c Inspector G- pate