HomeMy WebLinkAboutDrain Layers Permit 41 Pleasant Valley R TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT E E}0 0
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Pursuant to written application, permission is hereby ranted t the Lic nsed Drain Layer
named herein to perform the work indi aged below at `�
at premises owned by { , S C�cAt whohe address is
,)CA and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for S , ; 1 occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected y(nyhis 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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SPECIAL CONDITIONS
Desired Starting Date V,, 7 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 Draln 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 .Inw ZA
Licensed Drain Layer
The above named Drain Layer has a valid licen a issued y the State of Connecticut and
has filed a satisfactory bond and insurance policy
in the na a of the jT of South Windsor:
E ginee ing tment Date
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Connection Charge Paid 04=� 6// �PerLt Fee: Paid $
C eck umber Z
Issued by 7
Tax Office t/
INSPECTION
Date work started ���5'—� _ Date completed
Sufficient notification received: es No
Special Conditions
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APPROVED: . Z
Inspector Date