HomeMy WebLinkAboutDrain Layers Permit 79 Pine Tree Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5237
c
190
Pursuant to written application, permission is hereby ted�tq�the L' ensed Drain Layer
named herein to perform the work indic ted below t
at premises owned by whose 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 (4,)-, INDUSTRIAL
WASTES ( ), OR ( ) I �` Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
T
f
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 G
L tensed 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 t name of the Town of South Windsor:
J�J - Engineering Depa finent Date
Connection harge Paid "�`�J� Permit Fee: Paid $ 15 Lo /
r��
-5 a Check Number
Issued by 4/1
Tax Office �� L
INSPECTION
Date work started / Date completed
Sufficient notif ication eceived: Yes No
Special Conditions
APPROVED:
Inspector pat