HomeMy WebLinkAboutDrain Layers Permit 1608 Mill Pond Drive :• < ,
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19�
Pursuant to written application, permission is h ebb gr me to the Li ease Drain Layer
named herein to :per£orm th work i icated-,belo ;at.. 71at premise's' owned- :by , _ whose: address is
and'to
Lay House Drain, Repair House ,Drain:; 'Lay Main:,' ' -' Otfier ,
for occupancy or-)a 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 Xstixa;4ed-4Time for Completion
Permit_ to be issued to >. ^'
the holder of Drain Bayer's ,License. No Permit• *ill •expire thirty ( 0) ;days
after date of issuance' The undersigned Drain Layer hereby ag ees:.to all the teitns„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. Dzain Layer has a valid:, license issued by thejState'of Connecticut and
has filed a satin actoxy bond. and insurance olicy ,.in tf�e name of the down of"'South'Windsor:
eerin De
g g artment p Date
Connection Charge Paid (� �� :���' Permit Fee- Paid,
Check NumberT_
issued b
Tax ffice _
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date