HomeMy WebLinkAboutDrain Layers Permit 15 Niederwerfer Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
15 AU: e -3984
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to. perform,.Ipp e work indicated below at
at premises �ovned by '
��•2.w �t `J re � whose::address is
and .to
Lay House Drain, Repair Housd`-brain, 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.
i
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 (30_) days
after date of issuance. ' The- undersigned, Drain Layer hereby agrees to all ttie 'terms and
conditions set forth in the permit and the reverse side thereof.. Applicant has received
Town Permit No. and/or CHD ,Permit No.
Signex ou..
Licensed Drain; er
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satiractory bond and insurance policy in the name of' the Town of South Windsor:
ngineering Department Date
Connection Charge Paid _V00 -U 0 Permit Fee: Paid $
Check Number E�
Issued by
Y
Tax office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date