HomeMy WebLinkAboutDrain Layers Permit 27 Stonehenge Drive TOWN OF SOUTH WI N DSOR
,DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT to, 4793
dDr
Pu ant to written application, permission is h 'eby granted to the Licensed Drain. Wer
named herein to perfory; the work indicated bel w at
at premises owned by f who a address is
and to
Lay House Drain, Repair House Drain, Lay Main
for , Other
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.
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion Y, �� , •.j
.,I
Permit to be issued to L
the holder of Drain tayer's License No. Z�� S L y 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:
Erigineeriing Depar ment Date
Connection Charge Paid Permit Fee: Paid
Check Number
Issued by
i 1 Tax Office
V
INSPECTION
Date work started Date completed / �'
Sufficient notific tion received: Yes No
Special Conditions ; le i7a-T7
APPROVED
Inspector p tle