HomeMy WebLinkAboutDrain Layers Permit 84 Natsisky Farm Roa TOWN OF SOUTH WINDSOR
DEPARTMENT OF `PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO 4491
W �75151G1 �Xjjw 19,
Pursuant to written application, permission is,hereby granted t� the Licensed D ain Layer
named herein to perform the work indicated b lowt / r. r 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: SEWAGE ,
WASTES ( ), OR ( ) SANITARY ( ) INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date / -- i �_ Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. rr
ft- 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._.
Licen ed 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 Permit Fee: Paid
't 't
Check Number f
= f;,�= i;( Issued by
Tax Office
INSPECTION
Date work started
Sufficient notification received: Yes Date completed
Special Conditions No
APPROVED:
Inspector Date