HomeMy WebLinkAboutDrain Layers Permit 608 Sandstone Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
0
Pursuant to written application, permission is hereby granted to the L' ensed Drain Layer
named herein to perform.the work indicated below,at
at premises owned- by t+_�,in P" p �� ? 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."
SPECIAL CONDITIONS
Desired Starting -Date Estimated- Time :for :Comp.letion
Permit_ to be issued to'
the holder of Drai "„La s Li" ense N Perm' will eXpirehirky {3Q) 'days
after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and
j conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. - and/or- C"HD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a valid license issued bylthe 'State of'Connect'icut and
has filed a satisfagtory bond- and insurance policy in the name of the Town of South 'Windsor:
Engineering-:Department Date
Connection Charge Paid ��UO.�>J Permit Fee: Paid $
Check Number
[ -t Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date