HomeMy WebLinkAboutDrain Layers Permit 607 Sandstone Drive aRy t.,. >, .. t, < ...•xw. ... -00j("z^,9:,�.<,y#, ��� E.!W.�Rf ,: x-w� f -r •.� ;w ;
TOWN OF SOUTH WiNDSOR
DEPARTMENT OF PUBLIC WORKS f?''
BUREAU OF POLLUTION CONTROL ; '
DRAIN LAYER'S PERMIT
77-- , 19
Pursuant to written application, permission is here y g ed o the L ensed Dr in Layer
named herein, to perform theworm ndicated elow, at
at premises owned by /-� whose address is
..and to
Lay House Drain, Repair- House Drain, t1ay Main, Other ,
for occupad:cy 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 Estimated Tine for Completion
Permit_ to be issued `to
the holder of Drain Layer'license No. Permit will expire thirty (30) days
after-date of issuance. The undersigned Dra"i 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 in the name of the Town of Soutfi Windsor:
Eng.ineering :Department Date
Connection _ arge Paid l ,td / Z Z' Permit Fee: Paid $ 50V � Z
Check Number Gil/
i
Issued by
`� Tax Office ;
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date