HomeMy WebLinkAboutDrain Layers Permit 66 Sally Drive (2) TOWN OF SOUTH WiNDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
3960
V 9 , 19 -
Pursuant to written application, permission is ereby ranted to the Licensed Drain Layer
named herein to. perfo he work i icated 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 p oposed work or furnish two (2) copies of separate drawings.
f
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit- to Abe 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 ierms -and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has. a valid license issued by the Statg,of Connecticut and
has: filed a satisfactory bond and insurance policy n the naive of the•�T of`South Windsor:
Engineering Department Date
Connection Charge Paid -3 � � 7' Permit tee: Paid $
/ Check Number ]
Issued by
Tax f ce
j
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
I#spector Date