HomeMy WebLinkAboutDrain Layers Permit 15 Stonehenge Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS #-►Y
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 495.1
V 19 16
Pursuant to written application, permission is hereby gra ted to/the Licen ed ain Layer
named herein to perform the work Indic ted. bel w -atJf /L7 Ke- �S
at premises owned by ' whose:address is
and to
Lay House Drain-, Repair Piouse 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 Completion
Permit_ to be issued to'
the holder of brain Layer'p -License Ijo. Permit will expirey-thirty (3G) days
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after date of issuance. Tie undersigned Drain Layer hereby agreesto 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. Iayer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance• policy 'n the namA of the Town of South Windsor:
Engineering .DipaitmeK Date
Connection Charge Paid 'dye) o d permit Fee: Paid, $ Jam;00
Check Number
Issued b
4 y
Tax-Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate