HomeMy WebLinkAboutDrain Layers Permit Nutmeg Road South (2) TOWN OF SOUTH WI N DSOR
1 � DEPARTMENT OF PUBLIC WORKS
,nA .AO BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNIul. 46 I g
19
Pursuant to written application, permission is hereby granted to the JAicensed Drain Layer
named herein to perform the work indicated below at
at premises owned by .IA
whose address is
La House Drain and to
y Repair House Drain, Lay Main, Other for ,
Family Units, with acres. occupancy or use, with
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 COND TIONS 1
Desired Starting Date Estimated Time for Completion
'Permit to be issued to
the holder of Drain Layer's License 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.
Signed`"
Licensed Drai ayer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policyp'in the name of the Town of South Windsor:
Engineering Dew��ment Date
Connection Charge Paid G", (�l'v � /L � -7 Permit Fee: Paid $
Check NumbV 7 5"? Z-
Issued byA r 1
. Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate