HomeMy WebLinkAboutDrain Layers Permit 10 Robins Wood (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ®. 4190
' 19
Pursuant to written application, permission is hereby ra ,t,,d to the Licensed Drain Layer
named herein to perform the work in54cated below at� 5y-
at premises owned by �, �-�/ —° w address is
and to.
Lay House Drain, Repair HouseDrain, Lay Main, ' Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
S WASTE ( ), OR ( ) �. r, Connection will be made with
Show sketch of proposed work or furnish two (2) copies of sepa' ate drawings.
01 t-
I� L-J �
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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 2-
Licensed Drain Layer —T
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 Tow
D of South Windsor:
Engineering Departbzjefit Date
Connection Charge Paid ) _ �� nay ��y Permit Fee: Paid $ kj, 0 0
Check Number
JA tr/ t Issued by
Tax f3 fice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
nspector Date