HomeMy WebLinkAboutDrain Layers Permit 109 Sand Hill Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL"
DRAIN LAYER'S PERMIT a. 4364
16q
AVLX
Pursuant to written application, permission is hereby r nted to Vie„ Licensed Dr ain Layer
named herein to performthe,. or indicated; below/at `., �" y � �� ,.�, / i
at remises owned by 1 ' r—r- y s
P ,E' �`�—�1,�.(i�,f',h./ whose 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 (k)-l-""INDUSTRIAL
WASTES ( ), OR ( ) C�nn tion will be made with
Show sketch of proposed word'+r_-furnT2�--Ga"p' f-se p' rate rawings.
v,
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 41J ' Permit will expire t irty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to .31 the terms and
conditions set forth in the permit and the reverse side thereof. Aplc, nt has received
Town Permit No. and/or CHD Permit No. f
Signed
i ense Dr n Layer
The above named Drain Layer has a valid license issued by e Stat of Connecticut and
has filed a satisfactory bond and insurance policy the name €-the Town of South Windsor:
Engineering Department ' Date
Connection Charge Paid �� r�25 j!`� Permit Fee: Paid $
Check Number ' 7j
J'1 0 Issued by
Tax office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate