HomeMy WebLinkAboutDrain Layers Permit 169 Quarry Brook Dri TOWN OF1.11`1OUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Sill ",
�151 I q �►UU1� 19,
—
Pursuant to written application, permission is hereby grajite- to the Licensed Drain ayer i
named herein to perform the work indicated below,at - '/ ' _ �' ram' � ��
at premises owned by ��� - x.� why' se ad ess is
aid 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 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's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned—DR—in Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverseside thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
r
Signed -22
r 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 name of the Town of South Windsor:
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ai
Engineering DepFartment ' Date
Connection Charge Paid Permit Fee. Paid
Check Number �Jf��jrD �✓ {�4
f�/ Issued by
Tax Office
INSPECTION
Date work started Date completedo .
Sufficient notification received: es No
Special Conditions
APPROVED: / -Z ;
Inspector `' Date