HomeMy WebLinkAboutDrain Layers Permit 55 Natsisky Farm Roa TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ® 4598
55 Na scsrr� ern �l• A3 , 19
Pursuant to written applic tion, permission is he b granted to the Li ens Drain Layer
named herein to perform wor indicated be ow at %
at premises owned by _ 7 L
Whose address is
Lay House Drain, Repair House Drain, La Main, and to
for yOther
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE
WASTES ( ), OR ( ) { ), 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. 'lG%7 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.
Signed 4:2
Licensed Dra 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 the name of the Town of South Windsor:
?'n i Bering Depart�-ment Date
Connection Charge Paid&if4Lkermit �P Fee: Paid $ ,�� _ 71 2
y
Check Number
Issued by �..
Tax Iffice
INSPECTION
Date work started
Sufficient notification received: Date completed
Special Conditions Yes No
APPROVED:
Inspector pate