HomeMy WebLinkAboutDrain Layers Permit 40 Stonefield Trail�� .... .. .� ;... s..._. .. yt:• ... ...,:..:.: s _•sY .. s a. *r:A:...iPa. • _ _R :3^S'P._ r ..
TOWN Of SOUTH _ WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNTv. 4937
i
19d
Pursuant to written application, permission is hereby granted tto the Licensed Drain Layer
named herein to perform the work indicati�d b low at u ` ! <' ° /
P ,/ �.f--�Y l� tam-�t�
at premises owned by - C-%� 2 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 proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Comple ion
Permit to be issued to �&'44'r V
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 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 Layer.
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 the name of the Town of South Windsor:
- -.?'�?
g neering Department -�-_ Da e
Connection Charge Paid Z jl 0 , Permit Fee: Paid $ S /3/k
Check Numbe-r
/ Issued by .
Tax Office
INSPECTION D' L
Date work started Date completedQgT_
Sufficient notification received: Yes No
Special Conditions
APPR /
Inspector pate