HomeMy WebLinkAboutDrain Layers Permit 64 Stanley Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT , ? 051
19&�
Pursuant to written application, permission is her �r�n.ted t e L censed Drain Layer
named herein to perform the work indicated'below at. �Y
at premises owned by whose address is
and to
Lay House Drain, Repair House `Drain, Lay Main, Other ,
-__-'
for occupancy or use witit
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 trao (2) copies 'of separate drawings.
SPECIAL CONDITIONS .
Desired Start ifig:-Date Estimated Time for;:Comp;letion
Permit_ to be issued- to
the holder of .Drain'Layer"s lic.ense 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
,ahe permit and the reverse side thereof. Applicant has received
Town Permit -and/or.CHD :Permit No.
Signed
- Licensed Drain Layer
The above nam04. brain Layer has a valid license issued by' the 'State"of Connecticut and
has filed a sates ac ory bond- and insurance policy .in the name, o "the To."wn of. South .Windsor:
Engineering :Department. -Date
Connection Char a Paid � Permit Fee: Paid $ i L j
Check Num r
' Issued by " C-
1 Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date