HomeMy WebLinkAboutDrain Layers Permit 82 Saddleback Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITS. 4745
Pursuant to written application, permission is ereby 4r ed �7,the Licens#d-Drain Layer
named herein to perfa th work in ica ed below,at - } �` , -CL4
at premises owned by l , , c,u whose address 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 ( ), 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 -777777 Estimated Time for Completion
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 tayer 4'ere-by agrees to all the terms and
conditions set forth in the permit and the reverse side th4reof. Applicant has received`
Town Permit No. and/or CHD Permit No.
r
Signed
Licensed Drain` aver
The above named Drain Layer has a valid licensor sued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in,,.tie name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid ,o Permit Fee: Paid $
Check Number ( }
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date