HomeMy WebLinkAboutDrain Layers Permit 601 Sandstone Drive TOWN Of SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT wo
19�6
Pursuant to written application, permission is hereby �rant d to the Licensed Drain Layer
named herein to..perform;the work indicated below-at :(!moo
at premises owned by a; IJ6p. whose address is
and -to
Lay House Drain, Repair House Drain, 'Lay Main, -Other ,
for occupancy or use, with
Fancily 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 Drai}},L4yer'-$aLicense:NQ;, _. Permit w.til, exo ri- thirty <30Y,�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 CH,D Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a valid license issued by tte State of Connecticut and
has filed a satisfactory bond and insurance. policy in'the name of the Town of* South.Windsor:
�6o+- C� -.:)5.=j
Engineering Department Date
Connection Charge Paid 00 Permit Fee: Paid $
Check Number �/q1
;Z, Y2,Zfu ( CeLu. Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date