HomeMy WebLinkAboutDrain Layers Permit 441 Quarry Brook Dri s
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
, A
Pursuant to written application f
permission is hereba' ted to the Licensed Drain Layer
named herein to perform the wor i dicated be lo
at premises owned by1 at
ose add- ess is
Lay House Drain, ___ Repair House Drain,' La Main and to
for ---- y Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE
WASTES ( ), OR ( ) ( ), INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
4
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No.
Permit Will after date of issuance. The undersigns Drain Layer hereby agrees xtor all htheyterms ands
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 i t e name of the Town of South Windsor:
Engineering Department Date
/
Connection Charge Paid
— Permit Fee: Paid
Check Number 0/
�
/D *L7
Issued by ;
Tax Office
i
INSPECTION
Date work started
Sufficient notification received: Date completed
Special Conditions Yes No
APPROVED c - 5_..%
-Inspector
Date