HomeMy WebLinkAboutDrain Layers Permit 75 Stanley Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q_ 4940
�15
Pursuant to"writtea application, permission is h b rante to--the Licensed Drain Layer
PP � P ��,Y..�g y
named herein to. perform th w rk ,* =lowat kW <f�`"' 4
at premises owned by � �- X Ubose address is 1
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 brain..Layer's -License No.. Permit''Wil , expire thirty,'(30-)-'_days
after date of issuance. The undersigned Drain Layer hereby agrees to'all the tends and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or EHD Permit No.
Signed
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 Soutih .Windsor:
Engineering Department Date
Connection Charge Paid 2- Permit Fees Paid $ S Z
'7,p Z4�f
Check Numbe
C' issued by
Tax Office 0
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date