HomeMy WebLinkAboutDrain Layers Permit 78 Natsisky Farm Roa TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITa, 4556
�g Ws,sky �Q,LnI f 19' r�Pursuant to written application
permission is ereby granted to the Licend Drain Layer
named herein to perfo;V the work. Indic fed bel w at--. . �.
at premises owned by ;i r i�:F' ' ' `-' `" �c y
t . r l`•; , - .w ose address is
Lay House Drain, Repair House Drain,1 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 for Completion
Permit to be issued to
the holder of Drain Layer's License No. r w"
Permit will expire thirty (30) days
after date of issuance. The undersigned. Dra 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
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:
Engineering Department Date
Connection Charge Paid,:,-" >;i! r�' :;1 d ?
Permit Fee: Paid $
Check Number
Issued by k
Tax G3 fice
INSPECTION
Date work started
Sufficient notification received: Date completed
Special Conditions Yes No
APPROVED:
Inspector Date