HomeMy WebLinkAboutDrain Layers Permit 39 Natsisky Farm Roa TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT X8. 460
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Pursuant to written pplications, fiermiss(ion is her bg� gr nted to the License
named herein to perform th work 'ndi¢ated below at 7 r_ Licensed Layer
at premises owned by
whose address is
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:WASTES OR SANITARY SEWAGE ( ), 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, rf' ermit 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.
Signed
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:
ngineering Department Date
Connection Charge Paid Permit Fee: Paid $ �'
Check Number <; L12
Jl
Issued by
Tax Office
\„1
INSPECTION
t
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date