HomeMy WebLinkAboutDrain Layers Permit 63 Natsisky Farm Roa F
TOWN 'OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT d, 4517
C�3 sis�G� �Cr,�'nc,2d .
�i ?' 191�-5
Pursuant to written a p ication, permission is her by anted to Phe icensed Dr in La er
named herein to perform e work i plicate below a �l1`Uj Y
at premises owned by
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 (INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
�oT 4W
i00
I (400M
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to cy�r�(.. r �'�{ 1Gy-►
the holder of Drain Layer's License No
3 Permit will expire thirty (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.(AO e 3),
Signed
—+"Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State_ o 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 c6 6 ta4f4l
permit Fee: Paid
$ id
Check Nu b6ry ;
% �y`
Issued by
Tax Office -
f.
INSPECTION
Date work started c-,2- 3" Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: Z_
ns.p ctor Date