HomeMy WebLinkAboutDrain Layers Permit 2 Old Parish Drive TOWN OF SQUTW W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3710
19(M7
Pursuant to written application, permission is hereby grante ' to a Lic,en ed rainLayer
named herein to. perform the ork i ated }elo at �T�Q (� S �d� c
at premises owned b�'`11.L f� �. ,J/&-a �C ; whose address is a
jj"
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 ( ), INDUSTRIAL
WASTES ( ), OR _( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit_ to be issued 'to
the holder of Drari Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all `the tests and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHID Permit No.
Signed
Licensed Dra n 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 in the name of the Town of South'Windsor:
Engineering Depa tment :Date
Connection Charge Paid z Permit Fee: Paid $
Check Number
Issued b
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date