HomeMy WebLinkAboutDrain Layers Permit 72 Natsisky Farm Roa TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT X0. 4518
72- Oufrishl Qd- l �- L 3 , 19 �C�
Pursuant to written application, permission is hereby granted to the Li a sed Dra Layer
named herein to perform , a work indicated below at 0;"j �2 at premises owned by
whose address is
La House Drain and to
3' > Repair House Drain, Lay Main, Other for ,
Famil Units with occupancy or use, with
3' � acres.
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.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. gip %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.
Signed
Liceneed 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
a
Connection Charge Paid ( /y 7 2s s
Permit Fee: Paid $ /1� c ,
Check Numbe_r�'
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date