HomeMy WebLinkAboutDrain Layers Permit 1703 Mill Pond Drive b
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TOWN OF SOUTH WINS
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL. '
DRAIN LAYER'S PERMIT 3812
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Pursuant to written application, permission is eby ranted to th=Licensed-Drain Layer
named herein to perfoiA. thqj work in cated . elow. t'
at premises -owned- by whose add ss is
and to
Lay House brain, 'Repair: house' Drain,' -Lay'Main, Other ,
for occupar.icy or use,:. with*
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR O Connection will be made.with
Show sketch of proposed work-or furnish two '(2) copies of separate drawings'.
/71�3
SPECIAL CONDITIONS
Desired Starting-Date Estimated:Time for Completion
Permit- to be issued--to
the holder of Drain Layer',s -acense No. ,. Permit will -iffW611thitty (30)- days
after date of issuance. The undersi ned Dr Layer hereby agrees to a� l the t � i'' and
g Y Y g ,. . , �, :,�
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 I;ayer- has a valid` license issued by the`State'of Connecticut and
has filed a satisfactory bod;. and insurance policy,-,in the name of"`the Town�of.,South Windsor:
ETiginffering.:Department Date
Connection Charge Paid 'Permit"Fee: Paid
Check Number
/1-1 J 0 j ,jlf�' ,.'Issued by
Tax 0 fice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date