HomeMy WebLinkAboutDrain Layers Permit 11 Pheasant Way TOWN OF SOUTH WI N DSOR Ph e4,�an�
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
BRAIN LAYER'S PERMIT k5474
19_
Pursuant to written appUication, permission is her by granted to t e icensed Drain Layer
named herein to perform the work indic ted below at 1� a ;�
at premises owned by S/:-�"� C, r wh se 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 (�, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish-,two (2) copies of separate drawings.
P ,
SPECIAL CONDITIONS
Desired Starting Date / /Estimated Time for Completion
Permit to be issued tothe holder of Drain Layer's License No. Z o 8 yf 2_._, 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 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 in the name of the Town of South Windsor:
g Engineering Department Date
Connection Charge Paid 6V_0 Permit Fee: Paid $ f
Check Number
Issued by
Tax Office
4
`CPECTION
work started Date completed
cient notification received: Yes No
1 Conditions
APPROVED: (•
Inspect r Date