HomeMy WebLinkAboutDrain Layers Permit 14 Stanley Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 109 3734
1N 5�" br , 12 , 19ej
Pursuant to written application, permission is he
�b granted to t e Li used Drain Layer
named herein to perform the w rk dica ed below at ��
at premises owned by 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 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.
Signed �' c
Licensed Drain-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 in the name of the Town of South.Windsor:
Engineering Department Date
Connection Charge Paid /�/,Od- Permit Fee: Paid $ /U
Check Number JQ 601 ,
vtc 2 Issued by
T x Office
Y�ov a a
INSPECT ON
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date