HomeMy WebLinkAboutDrain Layers Permit 95 Stanley Drive I'
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
$uREAU OF POLLUTTbN CONTROL
s
DRAIN LAYER'S PERMIT
rVe , 19�s
Pursuant to written application, permission is hereby granted t the Lic sed Drain Layer
named herein to. perform thee
work in ica ed . ow..at- - .�,. ,
at premises owned by i:; whose,address is
and to-
Lay House Drain, Repair llouseDrain __, JLaY in, 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'. 'f*separate drawifigs'.'
SPECIAL CONDITIONS
Desired Starting Date = Estimated Time for Completion.
Permit_ to be issfted__�to
the holder of Drain Layer's hcense: No: . Permit Will expie''ahirty (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/o;r. CHD Permit No..
_Signed
Licensed Drain' Layei
The above named.: Drain Layer has a valid iicense issued by' the State' of 'Connecticut and
has filed a satisfactory`bond and insurance policy,; the ri e`: f: the flown' of. $outli`Windsor:
Engineering egar<tm t ,Bate
Connection Charge Paid `?Q ' 1'?4Peru Fee:^ Paid $ Z) / /Z��
Check Number l0
,I
Issued by
Tax Office i
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date