HomeMy WebLinkAboutDrain Layers Permit 145 Pine Tree Lane TOWN OF SOUTH WINbSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL r�Q
DRAIN LAYER'S PERMIT
Pursuant to written application, permission is hereby gran t-o th icen@0 Drain Layer
named herein to perform work indicated below:at
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 p rm t: 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 stimated Time for Completion
Permit- to be issued to
the holder of Drairi'Layer's -License No. Permit will expi t rty (30) days
after date of issuance. The undersigned Drain Layer hereby agree ; t 1 the terms and
conditions set forth in the permit and the reverse side thereof. .p c nt has received
Town Permit No. and/or CHD Permit No.
i
Signed A
Li 'else ra in ,layer
The above named Drain Layer has a valid license issued h€ t onnecticut and
has filed a satisfactory bond and insurance policy theof—le Town of 'South`Windsor:
Engineering .Department Date
Connection Charge Paid Permit Fee: Paid $
Check r glal ,Aft4-c 3 �w
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date