HomeMy WebLinkAboutDrain Layers Permit Nutmeg Road (3) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by H F-r whose address is
lU U TYII and to
Lay House Drain, Repair House Drain, Lay Main, Other
for t^"0/ l-,c ,L, ,U 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.
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SPECIAL CONDITIONS `
Desired Starting Date //I,�9; � Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. �,-5 cL4L2 Permit1will 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 t . /�.
-r
Licensed 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 polio in �he name f?,the Town of South Windsor:
ngine, r'-ig Department Date
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Connection Charge Paid`�� t C 1 `
g _ � � l/�, Permit Fe Paid $
tck, umber 111)
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Issued by
Tax Office
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INSPECTION
7J
Date work started Date completed
Sufficient notification received: Yes No
Special.Conditions
APPROV
Inspector Date