HomeMy WebLinkAboutDrain Layers Permit 36 Stephanie Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT lJ' 9,
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Pursuant to written appslica ion,. pe ViAss on is herejby .gran ed to the L3cen$ed. Drain Layer
named herein to perform a work indicatied'b low.at .0 u'%C r`rzy fic�
at premises `o'wn.e&by t ;` j whose address is
_ and to
Lay House Drain, T epaii use-Drain,' `Lay 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 of separate drawings.
SPECIAL CONDITIONS
Desired Starting -Date Estimated Time for- Completion
Permit- to be issued to
the holder of Permit "11 expite thirty (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/or CHD ,Permit No.
Signed
::Licensed Drain Layet-
The above named. Drain Layer has a valid license issued by` the State' of Connecticut and
has filed a satisfactory bond and insurance policy in thg. name of' the Town of- South Windsor:
Engineering Department. Date
Connection Charge Paid . ` i,f�h"; " Permit Fee: Paid $ -0
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Suff#ient notification received: Yes No
Special Conditions
APPROVED:
Inspector pat