HomeMy WebLinkAboutDrain Layers Permit 22 Natsisky Farm Roa TOWN OF SOUTH WI N DSOR
DEPARTMENT OF�PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
' 1
DRAIN LAYER'S PERMIT b, 4470
22 "sKa
named herein to perform. �►M �• '
Pursuant to written app,the lication, permission is hereby- granted to; the License
djDrain Layer
work indicated below at Z,
at premises owned b l
Y whose address is
v
Lay House Drain, Repair House Drain, La Main and to
for Y , Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), IND
WASTES ( ), OR ( ) USTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated
qm tor Completion
Permit to be issued toixa��ty
the holder of Drain Layer's License No. Permit will xpirethirty 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 received
Town Permit No. and/or CHD Permit No. -
Signed
/:Licensed Drain f ayer
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
Issued by
Tax Off ce
INSPECTION
Date work started Date completed
Sufficient notification received: Yes W No
cial Conditions
APPROVED:
Inspector Date