HomeMy WebLinkAboutDrain Layers Permit 51 Saddleback Drive TOWN OF SOUTH WI N DSOR 1�rf
DEPARTMENT OF PUBLIC WORKS 4
BUREAU OF POLLUTION CONTROL 7 ��
DRAIN LAYER'S PERMIT 1`N ) 4
51 So d & ba cK Dr . , 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform th wor ind' ated below at H-r ;L n ^c�rwv
at premises owned by �/ 41tl p 971-� whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, wi
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 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 Layer's License No. Armit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer a eby agrees to all the terms and
conditions set forth in the permit and the reverse ide hereof. Applicant h s received
Town Permit No. and/or CHD Permit No.
Sign?issued
Licensed ain Layer
The above named Drain Layer has a valid licen by the State of Connecticut and
has filed a satisfactory bond and insurance policy ' t e name of the Town of South Windsor:
i Engineering Department Date
Connection Charge Paid 6zf-�- Permit Fee: Paid $
Check Number 7 YY 9
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date