HomeMy WebLinkAboutDrain Layers Permit 72 Northview Drive TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19
Pursuant to written application, permission is hereby gran ed to th Licensed Drain Layer
named herein to perform the work i dicated below at
at premises owned by / A e ,z ��2 whose address is
7 -,). A'L*i /J , - and to
Lay House Drain, Re air House Drain, Lay Main, Other ,
for ,q r occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (`'INDUSTRIAL
WASTES ( ), OR ( ) Connecti w' 1 be made with
l/
Show sketch of proposed work or furnish two (2) copies of separate drawings.
1
i
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued fo
the holder of Drain Layer's License No. �> )� Permit w 1 expire thirty � 3 0 dais
after date of issuance. The undersigned Drain Layer hereby agrees to all P berms and
conditions set forth in the permit and the reverse side thereof. Ap ;n t s received
Town Permit No. and/or CHD Permit No.
Signed
Li !en ed -Drain Layer
The above named Drain Layer has a valid license issued by the S to- of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
all
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $ �
Check Number
Issued by � �f
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date