HomeMy WebLinkAboutDrain Layers Permit 92 Ronda Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
.` 53C-
Can
Pursuant to written application, permission is hereby
granted o the Lien ed rain Layer
named herein to perfor�, the work dic ed below at
p i es r G
at re o ed b
whose address is
and to
Lay
for House Drain, Repair House Drain, Lay Main, Other ,
o
Family Units, with acres. ccupancy or use, with
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 drawingslL
SPECIAL CONDITIONS J
Desired Starting Date n Estimated Time for Completion
� / /7
Permit to be issued to `1�� (_�j r1J S—7 -7L
the holder of Drain Layer's License No. 9- 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
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 policjn to name of ,fh Town of South Windsor:
V/ f
( E gineer- g \ partment Date
Connection Charge Paid !C 1a I g ��ermlt Fee: Paid $
3J Cti k:Nu berIssued by �
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
spe for pate
L
Construction Inspection Report
Project Dote
ov
Street
Weather In
Developer Contactor
Work in Progr
..e��
t
l � o �2;3
Problem Areas
Special Instructions/Orders