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HomeMy WebLinkAboutDrain Layers Permit 60 Natsisky Farm Roa OWN, OF, SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT ©• 4550 � -3 19E/ Pursuant to written application, permission is h reb granted to he L' ens Drain named herein to perfor� the wo k�indic ed a ow at Layer at premises owned by ) { ' wh se address is Lay House Drain, Repair House Drain, and to for --__ Lay Main, Other 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 forCompletion Permit to be issued to the holder of Drain Layer's License No. C�;14 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, Town Permit No. and/or CHD Permit No. Applicant has received 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: 04 �{ Engineering Department Date Connection Charge Paidp) Permit Fee: Paid $ Lp [� 14 Check Number Tax of ice Issued by INSPECTION Date work started Sufficient notification received: Date completed Yes No Special Conditions APPROVED: Inspector Date