HomeMy WebLinkAboutDrain Layers Permit 42 Rimfield Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
Pursuant to written application, permission is hereby gr t d to the Licensed Dirt L y ,r
named herein to perform the work indicated below at Z ,/,
at premiseso by AAwhose addre s is
and to
Lay House Drain, Z- Repair House Drain, Lay Main, Other ,
for Al �,-t,�.L V occupancy or use, with r ,�
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE M), INDUSTRIAL
WASTES ( ), OR { ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separa a drawings.
-77
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 ✓ �-4/ 4^.�
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 the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Pai +� $ \5o C3
g � �� Permit Fee: Paid
Check Number
Issued by
Tax Office
INSPECTION
Date work started 9 Z-j 9 ' Date completed 2-3 - 2
Sufficient notification rec ived: Yes No
Special Conditions
APPROVED- of
Inspector Date