HomeMy WebLinkAboutDrain Layers Permit 50 Pheasant Way TOWN OF SOUTH WINDSOR
y, DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT' 5236
Pursuant to written application, pi *ssion is hereby granted to the Licensed Drain Layer
named herein to perform,,the work indigat.ed below at +_;A
at premises owned by 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.
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t;
SPECIAL CONDITIONS `
Desired Starting Date Estimated Time for Completion
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Permit to be issued to
the holder of Drain Layer's License No. ,�p(o 9,S1� . 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 13. name of the Town of South Windsor:
Engineering Department ahate
Connection Charge Paid Permit Fee: Paid $
1 Check Number
byZ14%iRl Issued by
Tax Office
INSPECTION }
Date work started Date completed1
Sufficient notification received: Yes No
., Special Conditions
APPROVED: '
Inspector Date