HomeMy WebLinkAboutDrain Layers Permit 114 Sally Drive TOWN OF SOUTH'` WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT X?_3945
19
Pursuant to written application, permission is Pereby ant ed tot Licensed Drain Layer
named herein to. perfo the ox ind cated eiow at
at premises oQM 0 whose address is
_and to
Lay House D"rain, Repair House Drain, liq Main, Other ,
for occupancy or use., with'
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES O, OR ( } Connection will be. made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Dane Estimated Time' for,Completion
Permit- to be issued to'
the holder of Drain Layer' MTense No. Permit will expire thirty (30) °days
s_
after date of issuance. The undersigned Drain Layer hereby agrees to_all_ the te,tms'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 Conriec"ticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid h 4'�q6a Permit Fee: Paid
Check Number j / 7
/ n —
�G `h Issued by
J Tax office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date