HomeMy WebLinkAboutDrain Layers Permit 614 Rye Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
"
D i �.C� �
� 19
Pursuant to written application, permission is hereby gra ed to .t Licensed Drain Layer
named herein to perform, the work i�nd' ated below at 6 /1 i�
at remises ,owned by . � �� ��:�,
whose ad ess 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 �X), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposg work o furnish two (2) copies of separate drawings.
i
IV e sr
SPECIAL CONDITIONS i
Desired Starting Date e� Estimated Time for Completion - ec ,
Permit to be issued to
the holder of Drain Layer's License No. , Permit will expire thirty (30) days
after date of issuance. The undersigned Drain La er 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 ssued by the State of Connecticut and
has filed a satisfactory bond and insurance policy ilthe�name of th wn of South Windsor:
J� i /
,Eng neerir(g epartment Date
Connection Charge Paid
( � ��
g Peki#t Fee: Paid $
' ` (�Cl
Chec Number ' \�
Issued
by
Tax Office
i
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate