HomeMy WebLinkAboutDrain Layers Permit 245 Pleasant Valley TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT D 3735
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the w rk iodic ted below at Z ys .7 ..
at premises owned by whose a ress 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.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit- to be issued to
the holder of brain 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
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 in the name of the Town of South Windsor:
Engineering Department Date
"7JT/
Connection Charge Paid f h_3 Permit Fees Paid $ S l Ilk
Check Number -
Issued by (/(
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date