HomeMy WebLinkAboutDrain Layers Permit 109 Quarry Brook Dri TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
t
DRAIN LAYER'S PERMIT 1�No, 5 0 14
L) 19 (r-
Pursuant to written application, permission is hereby granted to the Licensed D din Layer
named herein to perform the _u�ok�indicated 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 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 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
6
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 /� ;i%/ ? Permit Fee: Paid $ G f
�, Check Number
is PLC. �' Issued by
i' Tax affice
INSPECTION
Date work started' Date completed - `' 's.l
Sufficient notification received: ,�1 Yes No !
Special Conditions
APPROVED: '`
Inspector Date
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