HomeMy WebLinkAboutDrain Layers Permit 17 Sally Drive TOWN OF SOUTH WI N DSOR
C� DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1.1 6
• �°� � -r 19 h
I
Pursuant to written app�catio , permission is here
named herein to perform the o.rk:-indicated bel w at y rant d to the LiFensed Drain Layer
at premises!-owned by �.�i?J� t;
°�'�- �' whose.address is
r.
La House fain,'- and to
3' , Repair House Drain, La Main,,: ,
for )' Other ,
Famil Units with occupancyer use,77
witl'
y acres. .
Type of Sewage to be connected under this permit: .SANITARY SEWAGE ( ),` INDUSTRL4L
WASTES ( ), OR, ( )
: Connection will be!made with
Show sketch of proposed work or furnish''tVo. (2) copies of p, separate draiaings,
SPECIAL CONDITIONS
Desired Starting Date .Estimated Time for-�Com letion
Permit_ to be issued 'to
the holder' of D&i1 U er!s License No
y Permit wiil expire thirty` (30)''days
after date of issuance. The` undeisigned Drain Layer hereby Agrees .to all the'tezals and
conditions set forth in the permit and the reverse side thereof. Applicant has' r";1. . d
Town Permit No. and/or CHD Permit No.
Signed
'Lieen:sed Drain Layer
The above named; Drain Layer has, a valid ficense'issued by'.the 'State og Connecticut and
has filed a satisfactory bond and insurance polic : ia .the name. of the Town of Soutti'Windsor:
'0 2
�nection
Engineering.DepartmentDate
Charge Paid /UU ti J Permit'Pee: Paig
V. Check Number
by
Tax fice
started Date completed s,
�notification received: Yes No
i tions
APPROVED:
Inspector Date