HomeMy WebLinkAboutDrain Layers Permit 70 Stonefield Trail TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT KID
.5
19rfs
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
! named herein to perform the work indicated below at i� f�,��a/J, � o
at premises-owned by U y - 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 EstirAated Time for Completion
Permit_ to be issued 'to
the holder of Drain Layer';s �License NQ. _ 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 CHID Permit No.
Signed
Licensed Drain Layer
The above namea. ,Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy 'n the name the To of' 5outh'Windsor:
Engineering DepartrWnt Date
Connection Charge Paid i/UU tl y Permit Fee: Paid $
Check Number 6
% J`y2 It,�k �.. _ � i` Issued by
Tax OfZce
' � /
INSPECTION
Date work started Date completed/
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date