HomeMy WebLinkAboutDrain Layers Permit 25 Pheasant Way TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ' 5 6 5a'
2, S 19 y/
Pursuant to written application, permission is hereby graptd to 4he Lice sed Dr in Layer
named herein to perform the work indicated below at 1�� (y
at premises owned by� whose address s
and to
Lay House Drain, — Repair House Drain, Lay Main, Other ,
for occupancy or use, with T-)a
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (�f, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawl
!-U
SPECIAL CONDITIONS
Desired Starting Date Estima ed Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Z. ermit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer ereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. Applica t 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:
En sneering Department Date
Connection Charge Paid";;�V- ,/-/ol/C/ Permit Fee: Paid $ \00S��
9 Check Number � ' � c'''�-C
Issued by 13Z2
Tax Office
INSPECTION
Date work started Z" 9 Date completed / 9/
Sufficient notification received: L.---Yes No T
Special Conditions
APPROVED:
I s ector Date