HomeMy WebLinkAboutDrain Layers Permit 390 Quarry Brook Dri TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL i
DRAIN LAYER'S PERMIT o./ 5013
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Pursuant to written application, permission is hergb gragted to the License Drain Layer
named herein to perform the wo indicated below at ill h
at premises owned by .� who fie 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 ( ) (J r. ;� Connection will be made with
J
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS 1 , ,_X
Desired Starting Date Estimated Time for Completion
Permit to be issued to Gi,`
the holder of Drain Layer's License No. ��7G ; 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.
f
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 t1 'name of the T of South Windsor:
Engineering Department Date
Connection.�t�Trge Paid L j/ ;�/ � -' Permit Fee: Paid
/ Check Number_
Issued by
Tax Office
INSPECTION
Date work started _j j 'J _ Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate
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