HomeMy WebLinkAboutDrain Layers Permit 32 Sally Drive TOWN OF S UTH W1 N DSOR
J i DEPARTMENT OF PUBLIC WORKS.
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
Pursuant to written application pkrmission is herQb/Y �ranted to he Licensed Drain Layer
` named herein to -perform t e w rk:�tdi . ed below at
' at premises- owned by 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 Estimated-.Time for Completion , ;
Permit_ to 6e issued `to`
_ the--holder of braix Laygr'S_ �L erise;_1��;. _'_ P0=: t wia.l expire Chirpy (30)z 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.* Applicant has received
Town Permit No. -and/or CHD .Permit No
Signed
Licensed Drain Layer_
The above named Drain 1: er has a valid license.issued by the Sta_ te'-of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of Souft 'Windsor:
Engineering Depirtme t .:Date.
Connection Charge Paid Q t) 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