HomeMy WebLinkAboutDrain Layers Permit 618 Pleasant Valley TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
r ere
BUREAU OF POLLUTION CONTROL
° 5042
DRAIN LAYER'S PERMIT �p,
o written application, permission is hereby anted to the Lice a Drain Layer
nam perform th work indica ed a� at
at ed by mkal -X hose 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 un r t p it: 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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,ova
SPECIAL CONDITIONS
Desired Starting Date - 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 Drain L er 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.
SignedIV
l6
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 o outh Windsor:
//
Engineering Depa Date
Connection Charge Paid 400,0(-) Permit Fee: Paid
Check Number �Q
Issued by
Tax Office
INSPECTION ✓ �'
Date work started Z Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
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