HomeMy WebLinkAboutDrain Layers Permit 1607 Mill Pond Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o 3825
1q�y
Pursuant to written application, permission is he by granted to th Licens d Drain Layer
named herein to. perfo ` t.th 'Work in cated. Blow, ..
at premises, owned..by w ose'.add�re s is
and to. A".
Lay House Dkain', Repair House'Drain, Lay` Main, Ofiher' ,
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. /j///,
/ W7
SPECIAL CONDITIONS
Desired Starting`Dafe - Estimated Time ,fo.r Completion
Permit_ to be issued-:to
the holder of Drain,Layer's -L ceYise No. "' Permit will expire"thirty {30')'days
after date of issuance. The undersigned Drain Layer hereby ;agrees ` to allathe: terms and
conditions set forth in the permit and the reverse side thereof. Applican�'lias received
Town Permit No. and/or CHD Permit No. ;. <.
Signed-
Liad sed`"D�ra"in L erg
oY
The above named,Drain Layer hee'a valid license issued by 0.1'"State`of Connecticut and
has filed a satisfactory bond., and insurance."policy',:an the naimp` of "'the Town of`, South Windsor:
Engine ing Department Date
Connection Charge Paid - � Permit Fee 'aicl $
` Check Number
,
! '� .-�' Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: l
Inspector Date