HomeMy WebLinkAboutDrain Layers Permit 15 Roy Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3771
Pursuant to written application, permission is hereby grantet2t the Licensed Drain Layer
named herein to pe.rfo the work indicated below at
at premises owned by ( whose-�address is
and to
Lay House Drain, Repair House Drain, 'Lay Main, " Other ,
r for occupancy or"'u� e, w tK `
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( } Connection w ll. 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 Drain' La eLno_ t W l ex i e the r (a�Q 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. 2lica.n h ' received
Town Permit No. and./or..CHD Permit No..
w Signed.
Licensed Drain Layer
The above named'Drairi Layer has a valid license issued by the State 'of Connecticut and
has filed a satisfagtory, bond and insurance, policy. in theme f the Town of' South;;Windsor:
y_ B5
Engineering Department pate
Connection Charge Pa �j 7f . C�� Permit Fee: Paid $ �(�
Check Number /�b
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date