HomeMy WebLinkAboutDrain Layers Permit 20 Stephanie Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT � r� _ 3
ao SrePMAJIS
Pursuant to written application, permission is hereby grante to the Li ensed Drain Layer
named herein to. perfo ,the work inw4cate below at a
at premises' owned by., 1'l�-4 ifty / Alt ` whose address is
:and to
Lay House Drain, Repair House Drain' Lay' Mai n, Other ,
for occupancy or.use with'
j 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 `lie issued
the holder of Drain Layer's -License No. Permie V#1 expire:thirty -(3U�}-'days
after date of issuance. The undersigned Drain Layer hereby agrees to all �the iertns.7and
conditions set forth in the permit and the reverse side thereof. Applicant has- received
Town Permit No. and/or CHD Permit No.
Signed
Lieensed-Drain.Layer
The above named I.rain Layer has a valid`. license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy 'n.the name, of .the Town of'South'Windsor:
.Engineering Departme :Date
Connection Charge Pad . 2�r Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date