HomeMy WebLinkAboutDrain Layers Permit 101 Rugby Lane TOWN OF SOUTH WIN DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMIT . 5 rs.
Pursuant to written application, permission is hereby granted to the 1.icenseq Drain L yer
named herein to. perform the work indica ted be� at �,%-,--:>;�� p / V j� �� 4-
at premises owned by "(, /Y 7 (: o e�,,/ whose add es is
> � J Iq it"I,v 15 ` i and to
Lay House Drain, V 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 proposed work or furnis ,t o (2) copies of separate drawings.
SPECIALCONDITIONS
Desired Starting Date , ,oV i ) /Sy Estimated Time for Completion!L'a�
Permit to be issued to
the holder of Drain Layer's License No. U 3 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 re#erse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed '/ 4 f
Licensed Drain Layer
The above named Drain Layer has a valid lice se istpued by the State of Connecticut and
has filed a satisfactory bond and insurance polic jin t'e name of t e Town of South Win sor:
E gineeri partment Date
Connection Charge Paid "�� �' �:D Per it Fee: Paid $ 15.
C` Check Number � ct
R �
Issued by
Tax @ffice
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INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
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APPROVED:
Pp
Inspect r pa