HomeMy WebLinkAboutDrain Layers Permit 18 Natsisky Farm Roa TOWN OF SOUTH' WI N DSOR
DEPARTMENT OF PUBLIC WORKS
ZZ BUREAU -OF-POLLUTION CONTROL
i DRAIN LAYER'S PERMIT jc. 4471
19
� Pursuant to written application, ei-m�issioan�is
hereby
granted to the Licensed rain Layer
/ named herein to perform ,the work indicated below at
at premises owned by `,r;•- - /4r1
r wh')se address is
and to
Lay House Drain, Repair House Drain, Lay Main,
for Other
Family Units, with occupancy or use, with
acres.
Type of Sewage to be connected under this permit:WASTES SANITARY SEWAGE ( ), INDUSTRIAL
( ), OR ( ) Connection will be made with
Show sketch of proposed work qr furn sh two (2) copies of separate drawings.
. f,_ - - '1 •s_ ��: ter:
SPECIAL CONDITIONS at
Desired Starting Date ~
stlmatecl j#0 for Completion
Permit to be issued to
the holder of Drain Layer's License No. 3 d.
Perm t--Vill 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.
Town Permit No, pplicant has rec ivied
and/or CHD Permit No.
Signed
i icensed Drain.,L er
The above nafhed 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 r -t it
Permit Fee: Paid $
Check Number
t } Issued by
Tax Office
INSPECTION
Date work started J %: <, Date completed
Sufficient notification received: -Tes No
Special Conditions
APPROVED: ' r>• r ; ;'
Inspector Date