HomeMy WebLinkAboutDrain Layers Permit 250 Nutmeg Road (2) 'r e 'r::: '�•j "- ,1351u L t Y Tn�!r _tiuvx [..-.a ,{�, ","�._-,`•,� !Y+ � -� ;..�Y '"�'^. ._::z,
TOWN OF SOUTH 1 D 'W N SOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT ®, 4717
19
Pursuant to written application, permission is hereby granted to the Li ensed Drain Layer
named herein to perform the work indicate ^)belo at
at premises owned by /�c hose 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 (�f, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
s'
P2-
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SPECIAL CONDITIONS 2._50
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire thirty (30) days
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. r,
Signed
Lim sed 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,-4n t —name of the own of South Windsor:
j `c '
Engineering Depa tment Date
Connection Charge Paid ; 5
c-) ) ,' Permit Fee: Paid $
Check Nu*e-)r
Issued by
Tax Office �
INSPECTION
Date worlt started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date