HomeMy WebLinkAboutDrain Layers Permit 19 Natsisky Farm Roa TOWN OF `SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 0, 4531
1WI 1 f
Pursuant to written application 19
, permission is Pere -y ranted tof the, Licensed Drain -
named herein to perfo the work, indJ ated low at }~' Drain,la er
at premises owned by r `� `
w ose address Jis
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with occupancy or use, with --
acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE
WASTES ( ), OR ( ) 'T, INDUSTRIAL
Co 1pe9tion will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Tim for Completion
Permit to be issued to
the holder of Drain Layer's License No
after date of issuance. The undersigned Dram Layer hereby r IL will xtore thirtythe (3O) days
agreconditions set forth in the permit and the reverse side thereof. Applicant has termsand
Town Permit No.
and/or CHD Permit No. pp
Signed �� � =�f
Licensed/Drai--n 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�h name of the Town of .South Windsor:
Engineering Department Date
Connection Charge Paid ► j `� , 3 a�, 5
Permit Fee: Paid $
r
Check Number
l Tax Office Issued by
INSPECTION
Date work started
Sufficient notification received: Date completed
Special Conditions Yes No
APPROVED:
Inspector Aate