HomeMy WebLinkAboutDrain Layers Permit 406 Mill Pond Drive TOWN OF SOUTH WiNDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
P DRAIN LAYER'S PERMIT Q 00
19
Pursuant to written application, permission is hereby gr ntted t the Licensed Drain Layer
named herein to. perfo "
th work in cated below.at e I�GcY Ph _
at premises owned by whose address is
and to
House Drain, Repair House Drain, Lay Main, Other ,
fo occupancy or use, with
Fa ly Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES O, OIL (. ) Connection will be made.with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting-Date Estimated Time for Completion
Permit- to be issued to
the holder of Drain; Layer's -License No. Permit will expire thirty (30Y days
after date of issuance. ` The undersigned brain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. Applicant 'has'received
Town Permit No. and/o.r. CHD Permit No.
Signed-
Licensed,.Drain Layer
The above named Drain Layer has a valid license'Issued by the State. of Connecticut and
has filed a satisfactory bond and insurance policy name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid ` Permit Fee: Paid $ 00
Check Number `�---
'�` Issued by Z4 . �11�
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate