HomeMy WebLinkAboutDrain Layers Permit 106 Natsisky Farm Ro TOWN OF 'SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o, 4547
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W,pDe .Pursuant to written app ication, peion is hereby_ grant�res , to the I, cen�d Drain Layer
named herein to perform he wor i dicated- (Blow ;at 3
at premises owhd by ) �{ f c � whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with 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. Z4 V(Z 93 . Permit will expire thirty (30) days
Y
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 -�-
icensed Drain er
The above named Drain Layer has a valid ~ ense issued by the State of Connecticut and
has filed a satisfactory bond and insurance olicy'Vin. "l a name of the Town of South Windsor:
. , �7
C
Engineering Department c ^Date
7
Connection Charge Paid / � , Permit Fee: Paid $ / / /A
` Check---Ndtitier
xf
�A4 Issued- by /
Tax Office
INSPECTION y r�7
Date work started bate completed
Sufficient notification r ceived: Yes No
Special Conditions
APPROVED:--
Inspedtor Date