HomeMy WebLinkAboutDrain Layers Permit 87 Natsisky Farm Roa TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT oU. 4574
g� �c 5(skq F&(m SEC. 19
Pursuant to written application, permission is- hereb
named herein to perform, the work indi�c�ted b low at 4', Y gr��ted to, the Licensed Drain Layer
at premises owned by S v_3
r � 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
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. 7 / , 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. 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 •n the name of the Town of South Windsor:
4ngineering'aDepartm t Date
Connection Charge Paid Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started
Sufficient notification received: Date completed
Yes No
Special Conditions
APPROVED:
Inspector Date