HomeMy WebLinkAboutDrain Layers Permit 145 Natsisky Farm Ro (2) TOWN 00.. SOUTIj WI N DSOR
/ DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ANO, 4870
V
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Pursuant to written application, permission is e
named herein to perfa th wor in cat d belox*at re y ranted to the(Licensed Dram yer
at premises owned by S � - �IVI t_ i,
hose address is
Lay House Drain, Repair House Drain, La and to
for y Main 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 or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
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 has rec
rain L ived
Town Permit No. and/or CHD Permit No.
Signed
Licensed Dayer
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:
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En ineering Depart e t
,,{{ D to
Connection Charge PaidEJ6 �T Permit Fee: Paid $ !j
Check Number
Tax Office Issued by
INSPECTION
Date work started — S
Sufficient notification received: Date completed
Special Conditions Yes No
APPROVED: _
Inspector Date^