HomeMy WebLinkAboutDrain Layers Permit 554 Pleasant Valley TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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' DRAIN LAYER'S PERMIT �'�No, 4935
F
J6 19
Pursuant to written application, permission is hereby grasnted to the Licensed Drain Layer
named herein to perform the work indicated below atat 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 ( ), 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 Estima d Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 2i Permit will expire thirty (30) days
after date of issuance. The undersigned Drain La er hereby agrees to al he terms and
conditions set forth in the permit and the reverse side thereof. ppl'ca t has received
Town Permit No. and/or CHD Permit No.
Signed
UE&rse ain er
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:
ngineering Department Date
Connection Charge Paid Permit Fee: Paid $
Check Number y y/
Issued by
Tax Office
i
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: /O Inspector pate f,{
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