HomeMy WebLinkAboutDrain Layers Permit 69 Sally Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
E
4 DRAIN LAYER'S PERMIT _
lPrlY �/
u suant to writ application, permission is ereby granted to the Micensed Drain Layer
named herein to psrfo the ork. 3ndi aged b low at
at premises owned by ! ' whose address is
and to`:
Lay House Drain, ,Repair`House brain,' . _ - '-Lay Main,, Other ,
for occupancy or u� ,se with
Family Units, with acres. '
Type of Sewage to be connected under this permit: ITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR- ( ) Connection will be made,with
Show sketch of proposed work or furnish two (2) copies o ; separate drawings.
s;
SPECIAL CONDITIONS
Desired Startin:g'Date Estimated Time for. Completion:
Permit_ to be issued -to
-- - the_holder of �oebrzQ,No• ..�.�
P ' xOUe thin (3 )-: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. CHID.P.ermit, No.
Signed
Licensed Drain Layer.
The above named Drain Layer has a valid license issuued by the ''State of:Connacticut and
has filed a satisfact Xy bond and. insurance policy in ttie name of 'aiie Town of South`Windsor:
En ne ri Department .Date
Connection Charge Paid ' �' �3 Permit'Feet paid '$
Check Number 1,10 y f-
Issued by
Tax affice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
\ APPROVED:
Inspector pate