HomeMy WebLinkAboutDrain Layers Permit 603 Sandstone Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4907
_7 Z- 19 4 b
Pursuant to written application, permission is hereby rante to the Licensed Drain Layer
named herein to perform tbi� work in icat:ed below at. &
at premises `owned by C" r whose address is
and to
Lay House Drain, - Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
I
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES O, 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 Drain Layer's2116ense No. Permit will expire thirty (30)`'days
after- date of issuance. The undersigned Drain Layer hereby agrees to all the t'65i and
conditions set forth in the permit and the reverse side thereof. Applicant ihas received
Town Permit No. -i 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 Permit Fee: Paid $
Check Numb
6
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date