HomeMy WebLinkAboutDrain Layers Permit 718 Pleasant Valley TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
) 50554u
DRAIN LAYER'S PERMIT NNo.
f ' 19
Pursuant to written application, permission is hereb granted to the Licensed Drain Layer
named herein to perform the work in icated 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 permit: SANITARY SEWAGE (��, INDUSTRIAL
WASTES ( ), OR ( ) Connect
ion will be made wi
th
th
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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• V
SPECIAL CONDITIONS
Desired Starting Date 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 tayer 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
Connection Charge Paid r Permit Fee: Paid
Check Number
r / _
Issued by
Tax Office
INSPECTION
Date work started — Date completed ^ Z -- ge
Sufficient notification received: es No
Special Conditions
APPROVED: Z
nspector Date