HomeMy WebLinkAboutDrain Layers Permit 43 Sally Drive {
TOWN OF SOUTH WI N DSORc
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ° 4234
Pursuant to written application, permission is }sere y �nt d to the Licensed Drain Layer
named herein to perfo the work irx icat d be��ow at
at premises owned by ,A whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other
for
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
7ztr c.-
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
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 DrainLayer 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 Layer has a valid license issued by the State of Connecticut and
has filed a;,satisfactory bond and insurance policy he name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $
Check Number
;�J✓ r i3 _�/ l�l i'� Issued by
J I Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date