HomeMy WebLinkAboutDrain Layers Permit 707 Sandstone Drive TOWN OF SOUTH WI N DSOR i
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT M. 4699
Pursuant to written application, permission is hereby grantel to the Licensed Drain Layer
named herein to perform the rk indicated below at —2 a ,2
at premises owned by whose address is
10 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 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 Drain La er 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 rai 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 the name of the Town of South Windsor:
ZC / 6 3 _u 7
Engineering Depar went Date
Connection-Ch r e g Paid Permit Fee: Paid $ S Z2_
Check Nu
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date