HomeMy WebLinkAboutDrain Layers Permit 57 Riverside Drive r
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT _ 3604
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Pursuant to written application, permission is he�rjeb� granted (,to the Licensed Drain Layer
named herein to perfoT the work indicated below:at
at premises awned by &Vvtl 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_Dra Lf '_ e4se,
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
The above named Drain Layer has a valid license.issued by the State of Connefticut and
has filed a satisfactory bond. and insrance policy in tlje name of the Town of _South'Windsor:
Engineering D partment Date
Connection Charge Paid IY00.00 permit Fee: Paid $ D
Check umb r 3
Issued by
Tax Of f ice,
1 4LZ
'
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate