HomeMy WebLinkAboutDrain Layers Permit 105 Stonefield Trail 3 b TOWN OF SOUTH W1 N DSOR
t �`) DEPARTMENT OF PUBLIC WORKS
LA- BUREAU OF POLLUTION CONTROL
U DRAIN LAYER'S PERMIT 3616
19
Pursuant to written application, permission is hereby granted to the Li ensed Drain Layer
named herein to. perform the work indicated below atfi Icy ✓'�v' fta ��. .. �0�
at premises owned`by (11V 12- whose address is
and to
Lay House Drain, Refnir °House Drain, 'Lay 41AIn, other ,
for occupancy of -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 drawing's'.'
SPECIAL CONDITIONS
Desired Starting--Date Estimated Time-for, Completion
Permit- to be issued to
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 bold and insurance policy in the name the Town of South Windsor:
Engineering Departrffent Date
Connection Charge Paid -V U Permit"Peer Paid $
Check Number
Issued by
Tax Off iee
d '
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date