HomeMy WebLinkAboutDrain Layers Permit 148 Quarry Brook Dri TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT r} o 5120
10 , 19
Pursuant to written application, permission is hereby rit ted to the Licensed Drain ayer/
named herein to perform the wor i icated bg9w at
at premises owned by wh• a add ess 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 be made with
Show sketch of proposed work or furnish tw6 (2) copies of separate drawings.
•
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's Lice: No. t,7 Permit will.expire thirty (30) days
after date of issuance. The undersigned DXin Layer hereby agrees to all the terms and
conditions set forth in the permlf and the/rdrerse side thereof. Applicant has received
Town Permit No. and/oY CHD Perkt 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 jai he name of the Town of South Windsor:
Enginee ing Department Date
Con ection Charge Paid /,��1 Permit Fee:• Paid
Check Number Q
Issued by
Tax Of ice
INSPECTION
Date work started /f ;� - �� Date completed
Sufficient notification received: a> es No
Special Conditions
APPROVED:
Inspectorr/ Date