HomeMy WebLinkAboutDrain Layers Permit 205 Natsisky Farm Ro s r TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLIgUTION CONTROL
DRAIN LAYER'S PERMIT 1 T fo. 5037
19 .
Pursuant to written application
permissiol& is
named herein to. perform the work indicated ow at below hereby gran�tpcL to the Licensed Drain Layer
at premises owned by 5
,.whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with occupancy
acres. 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.
` _ I
SPECIAL CONDITIONS -
Desired Starting Date Estimated Time for Completion -- ,
Permit to be issued to
the holder of Drain Layer's License No. , ,
after date of issuance. wi
The undersigned Drain Layer hereby greesPermixtor all htheyterms and
conditions set forth in the permit and the reverse side thereof. Applicant has recei
Town Permit No. and/or CHD Permit No. ved
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
Permit Fee:. Paid $
Check Number
Tax Office Issued by
INSPECTION
Date work started
Sufficient notification received: Date completed
Yes No
Special Conditions
APPROVED:
Inspector pate