HomeMy WebLinkAboutDrain Layers Permit 25 Natsisky Farm Roa TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N., 4516
19 6Y)
Pursuant to written application, permission is hereby ranted o the Licensed- Drain. Layer
' named herein to perform the-z�ork indicated elow at �_ e z`/ rti
at premises owned b , } . '� �`�' s ,,
y {;��`�'�{ whose address is
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( ),WASTES ( ), OR ( ) INDUSTRIALConnection 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 after date of issuance. The undersigned Drain Layer hereby agrees to all the terms ands
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No. ;t
Signed
+gaZ�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 ��u / 7/i �
Permit Fee: Paid $ �� j, 7. .Y
Check Number
Issued by
Tax Office
i
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
nspector at