HomeMy WebLinkAboutDrain Layers Permit 200 Pierce Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT I ®, 4420
100
Pursuant to written applic ion, permission is ereby ranr"d to the L c nsed rain La
named herein to. perfo _the wprk i d' ate below,;at g (f 3,c Layer
at premises owned by t--
�: , ` ' -A whose address is
' and to
Lay House Drain, VRepair House Drain, Lay Main, Other ,
for occupancy or use, wit �
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 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 sidelthereof. Applicant ha, deceived
Town Permit No. and/or CHD Permit No. t �`
Signed
Licensed Drain .Layer
The above named Drain Layer has a valid liceri a issued by the State of Connecticut and
has filed a satisfactory bond and insurance polic;,' i the ame of
the To of South Windsor:
Engineering Department Date
Connection Charge Paid Z2 (, t `/ j� Permit Fee: Paid $ t�
Check Number
Issued by
Tax 4 fice
vj
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date