HomeMy WebLinkAboutDrain Layers Permit 38 Rockledge Drive (3) r
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMI 3642
T
8
19
Pursuant to written application, permission is hereby granted /�o the Licensed Drain Layer
named herein to perform t e wok indicated .below at ox y c_ �jJ67Jr
at premises owned by u whose-address is
-. and to
Lay House Drain, Rep,4ir`House 'Driin, Lay Main, Other ,
for occupancy or'u with' r
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 roposed�,work' or "furni$h two (2) copies of separate drawings:
SPECIAL CONDITIONS
Desired Starting "Date - _ Estimated Time forr-Completion
Permit_ to `be issued to , v.
the holder of Drain' Laver s ;I:icen I+ g Permit i +j, eF ire t�birty �30�`" days,
-- - _ --issuance.
after date of issuance. " The undersigned Drain Layer hereby agrees to alY the terms.and
conditions set forth in the permit and the reverse side thereof. ' Applicant has received
Town Permit No and/or CHD Permit No.
Signed
{, Licensed Drain:Layer
The above named Dram;Layer—has a .valid license issued by;the State� of Connecticut and
has filed a satisfactory bond; alp insurance policy• in the name of ',th6 Town`of` South.;Windsor:
Engineering .Depar went Aate
Connection Charge Paid /Od 'd c) Permit Fee: Paid-•$
Check Number 7 9
Issued by . .
Tax D f'
INSPECTION_
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date