HomeMy WebLinkAboutDrain Layers Permit 1610 Mill Pond Drive TOWN OF SOUTH .41NA R
DEPARTMENT OF PUBLIC WORKS ;4
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PRMT,
1
Pursuant to written application, permission is 4ereby_ graniq to the 'cense Dxa"n Layer
named herein to perfo the ork in ated, b low at
at premises owned by . e/
whose: addre is
Lay House Drain; Repair House Drain, La Main and to
for , y Other•
Family Units, with o cupaa,cy or use, with
acres.
Type of Sewage to be`connected under this permit:
WASTES SANITARY SEWAGE ( ), INDUSTRIAL
O, 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 Timefor Completion
Permit_ to be issued- to'
the holder of Drain Layer's -Lic bse No. : `
�' Permit wild exp` rehf�ftr (30) °days
after date of issuance. The undersigned Drrdir"ayes hereby agrees.td 'all
conditions conditions set forth in the permit and the reverse side thereof. �Applican't has received
Town Permit No.: ,: and/or CHD Permit No. .
Signed
,.Liceftsed Drain;Layer
The above named' Drairi; Layer has a valid lice nse_issued by the'State'
of Eonrrec� c.ut and
has filed a satisfacoxy bond and insi}.rance, policy, in the:nam of .the To%1n of.South Windsor:
Engineering : .epartment Date
Connection Charge Paid' ���'�"���
Permit'Fee:- Paid'$ 0 , i
Check Number
/ Issued b'`
Tax �3f f is e
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date