HomeMy WebLinkAboutDrain Layers Permit 407 Mill Pond Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT X' O
, 19�
Pursuant to written application, permissL_L_z-z2_d��ion is hereby g anted_ to the L'cen d Drain Layer
named herein to perfo thework in ated b low at �
at premises owned- by r-
whose address is
Lay House Drain` iand to
Repair House'Drain
for ; Lay Main, Other`
Family Units, with occupancy or use, with '
acres.
Type of Sewage to be connected under this permit: SANITA
WASTES OR RY SEWAGE ( ), INDUSTRIAL
O� O ,.
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 Na
Permit chili to
rethifty' (30) days
after date of issuance. The undersigned Drain Layer>`hereby agrees' all 'the terms and
conditions set forth in the permit and the reverse side thereof. Applicant has receand
Irown Permit No. . and/or CHD Permit No.
Signed
_ "Licensed `Drain Layer :.
The above named prainay,er Y}as. a valid license issued by the 3tate"bf Connecticut and
has filed a satisac, ory bond and insurance policy n e'name of t "e Town of South Windsor:
Eng neering .Departmen Date
Connection Char a Paid
g Permit Fee: Paid
fi
Check Number ���--.•
Issued by
Tax E3 fice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date