HomeMy WebLinkAboutDrain Layers Permit 606 Sandstone Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 0
Pursuant to written application, permission is here�y gxereorto the i ensed Drain Layer
named herein to perform the work 3,n c fed 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 ( ) Connection will bemade-:with
Show sketch of proposed: work or furnish two (2) copies of separate drawings. 1
I
SPECIAL CONDITIONS
Desired Starting Date Estimated, Time for Completion .
Permit- to be issued to
the holder of Drain Layer's License No Permit will exAire 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 , n the name of, the Town of South .Windsor:
Engineering Department- ;Date
VA
Connection Charge Paid t• Permit Fee: Paid $ /r '•' '
Check Number 'f ^�
Issued by v
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date