HomeMy WebLinkAboutDrain Layers Permit 33 Sally Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4 4 2 8
Pursuant to written applicati permission is 4ereby granted to the icen
named herein to. perfoT the wor ind'c ted, elow at , _ sed Drain Layer
at premises owned by /' 177whose address is
Lay House Drain and to
for a Repair House Drain, Lay Main, Other ,
Family Units, with acres. occupancy or use, with
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
-1
Desired Starting Date 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 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.
Signed2
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
ineering Department Date
Connection Charge Paid Q ' ') { r; 1r'
G � (�� Permit Fee: Paid $
Y l - Check Number
ssued by
Tax Office
INSPECTION `
Date work started `! 0 2'3 �" Date completed 7_ j
Sufficient notification received: Yes No '
Special Conditions
APPROVED: -"c
Inspector Date