HomeMy WebLinkAboutDrain Layers Permit 66 Sally Drive r
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TOWN Of SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
Pursuant to written application; permission is
h reb gr nted to the L en$ed Drain Layer
named herein to perfo -the or ind cated/pelow :at
at premises owned by'- cLG whayse 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 trao'(2) copies of.; separate drawings:
SPECIAL CONDITIONS
Desired Startirig"Date Estimated Time for.Completion
Permit. to be issued=to"
the holder of Drai }La�yer'scene„N�. , '., Permit`Wil.. expire,thirty' ( 0.)'days
after date of issuance. The undersigned Drain Layer hereby agrees .to all the termg.and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. . ,.:and/or CHD Permit. No ..
;r Signed ..
`Lioensed- Drain Layer.
The above named Drain Layer •has. a valid license 'issued by the `State of Connecticut and
has filed a satisfactory bend and insurance policy in:tk�e name of the Town of,' 'out h-Windsor:
' Engineering Department.. Date
Connection Charge Paid -f-&101U3 Permit Feet (Paid
Check Number 6t
IA-IA-1-1 f &I r��
Issued by
Tax _ffice
INSPECTION !
Date work started L (�s Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: ja
nspector Date