HomeMy WebLinkAboutDrain Layers Permit 719 Sandstone Drive x
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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL t+�
DRAIN LAYER'S PERMIT—". o. 4 f o 5
19 ;
Pursuant to written application, permission is hereby gr ted to the Licensed Drain Layer
named herein to perform the wor indicated below at
atremises owned b
P Y � t 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 ( ), INDUSTRIAL
WASTES { ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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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 Layer 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.
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Signed
"Licensed Drain L er
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy 'ipn the name �theown of South Windsor:
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Engineering Depa ment D to
Connection Charge Paid �"T~,� �`- 7 Permit Fee: Paid $
Check l�x�n1), —
r &' Issued by .. /
Tax office
1
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date