HomeMy WebLinkAboutDrain Layers Permit 461 Quarry Brook Dri TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at %;,2-- �J(2
at premises owned by whose address is
' and to
Lay House( Drain, Repair House Drain, Lay Main, Other ,
for r. ,_,a ,, occupancy or use, with /
A � �
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.
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)
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion T77/7
Permit to be issued to
the holder of Drain Layer's License o. d 'Permit will expire thirty' (30) d#s
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 D ain L er
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:
-C'
Engineering Department Date
Connection Charge Paid Permit Fee: Paid
Check Number
Issued by
Tax Office —'
INSPECTION
Date work started — �� - 9 / Date completed
Sufficient notification received: &/ Yes No
Special Conditions
APPROVED: -jp—
Inspector Date