HomeMy WebLinkAboutDrain Layers Permit 29 Rockledge Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT , 36 5
_ of� f4o cK Cad.
Pursuant to written application; permission is he 5y grante4 to the Licensed Drain Layer
named herein to perform t e irk indicated below at
at premises owned by u 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 'proposeo Rork or furnish two (2) copies of separate drawings'.
SPECIAL CONDITIONS
Desired Starting'-Date Estimated Time for Completion
Permit_'to be. isi6dd to
the holder of Drain";Layer.$ Licenge _; Per _ thirty 3,9),days
after date of issuance. The undersigned ;Mn 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 CHID Permit No.
:Signed
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 he name of-the wn of-S 4th Windsor:
Engineering..Dep.ar/ ent Date
Connection Charge Paid �Lm.O d Permit Fee: Paid' $ 06
Check Number
Issued by .
Tax of f c
� G
INSPE TION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date