HomeMy WebLinkAboutDrain Layers Permit 110 Stonefield Trail TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q3652
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the word indicated below .at , fit, (1 *1 j p
at premises 2.orwfted. by ::whose:a'ddress is
and
Lay House Drain, epair''Abuse°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
i
Show sketch of proposed work or furnish"two (Z) dopies`.of separate drawings'.
SPECIAL CONDITIONS
Desired Startiig' Date - Estimated Time for...Completion
Permit_ to be iesued
the holder of Drain,', eras cense`'No "
Ley , " Permit will ex �re`t iff$ ( 0) 'days
„ —j-'
after date of issuance. T1�e undersigned Drain tayer`hereby agrees ,to "a�.l the'`tei�s sand
conditions set forth in the permit and the reverse side thereof. Applicant I ass received
Town Permit No:. and/or, CHD .Permit No..;.
Signed
- it -'Loy
Drain:Layer;::
The above named Ira i� Layer hays a valid license issued by the`'talte``of Connect' cut and
has filed a sat tory bond and insurance policy','in the name of`;the loran of` South'Windsor:
Engineering Department Date
Connection Charge Paid -4166';6 61'eririit beet Paid $ J l y
Check tuber D �
''.Irr-nll"-C t :�`f����� Issued- by //
Tax of f ice.
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date