HomeMy WebLinkAboutDrain Layers Permit 29 Stephanie Lane TOWN OF SOUTH WIN DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT (J` 0
19�
029,�¢phatl t.. Lc�_
Pursuant to written application, permission is ere gran ed to, the icensed r in Layer
named herein to..perfo+ thew 1 di ate elow t , '�[-� � ZLfJ<�, )� _.
at premises owned by whose"address is.:.-� -'
'and to
Lay House Drain, 104ir 'House Drain Lay Main., Other ,
for occupancy or ue, with
Family Units, with acres:
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ). Connection will be made with
,t
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 to
the holder of Drain,,Layer's:License No. ; Permit will, ekpire thirty: (30) days
after date of issuance. The undersigned Drain Layer "hereby,agrees"to- al'1 the terms. and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No.. and/or.iCID Permit No.
: Signed
Licensed Drain Layer-
.The above named Drain Layer has_ a..vglid license issued by the 'State-'of Connecticut and
has filed a satisfacto i bo-nd and insurance policy, name o the T_ wn of .South Windsor:
e7 AC:)
( �. 3 Engineering Department, Date
Connection Charge Paid ! "�7Fj' � �'3 Permit -Fee: Paid fT
Check Number
Issued by
Ta Of f ice
INSPECTION
Date work started ZBle Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date