HomeMy WebLinkAboutDrain Layers Permit 107 Natsisky Farm Ro (2) TOWN OF, SOUTH WINDSOR
DEPARTMENT OF PUSLtTC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT j®, 4611
Pursuant to written�p"pl At*io/nA%pe:;rm�isMsion is hereby granted to the Licensed Drain L er
named herein to perform the work indicated below at ) = y
at premises owned by '; , r yr_ � those 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. Zp gZ,7 3 . 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. licant has received
Town Permit No. and/or CHD Permit No.
Signed
Li, used Drain Laye
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy ip/ the e f the Town of South Windsor:
/ �i ` i
Engineeiin Depar ent Date
Connection Charge Paid *-10 Permit Fee: Paid
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate