HomeMy WebLinkAboutDrain Layers Permit 1701 Mill Pond Drive n71_ ;r ., . .
TOWN OF SOUTH WINS' {t
f
DEPARTMENT OF PUBLIC WORKS?,
�. BUREAU OF POLLUTION CONTROL
DRAIN LAYERS PEhMIT
4x t s + 3810
rr ', 19 L,.
Pursuant to written application, permissIion is reby`gr nted to the Licensed Drain Layer
named herein to perform t. e workindica ed below. at ,
at premises-owned. by whose addkess is
•and•.to:
Lay House Drain, Repair House 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
oV A '
/7
SPECIAL CONDITIONS
Desired Starting =Date Estimated. Time .for Completion
hermit, to be issued to-
the holder of Drain.. Layer's-License No Permit will ex ixe`'thirt
P Y (S0)•'days
after date of issuance. The undersigned Drain Layer hereby agrees "to.alb.` the terms; and
conditions set forth in the permit and the reverse side thereof. Applicant lassreceived
Town Permit No. and/or CHD Permit No. t
Signed .
Licensed'Draih'Layer
The above named. Drain Layer has a valid' .license issued by the State`'of Cons nect'icut and
has filed a satisfactory bond: and insurance policy X the name of the T;' of South'Windsor:
Eriginedring Department, Date
Connection Charge Paid fi -�9t' ' # '� Permit Fee: Paid
Check Number
Issued By'
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date