HomeMy WebLinkAboutDrain Layers Permit 86 Partridge Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT QF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �
s
Pursuant to written applicatibn, permission is he e y ante to the Licen ed Drain Layer
gx y
named herein to perfo the oork.i'nd'icate) be ow at � � �_.����,
at premises owned by f /M1-zl-� � whose address is
v
and to
Lay House Drain, Repair House Drain, Lay Main, IOther ,
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 drawing .
4
SPECIAL CONDITIONS
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.
Signed L✓---'��`� � �� - �-
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 policy i ,the name of th Town of Sough Windsor:
Engineering Department Date
Connection Charge Paid / ��'I j�(� Permit Fee: Paid $1�
Check Nu_mbj3,r S�
l Issued by .p
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspect r Date