HomeMy WebLinkAboutDrain Layers Permit 402 Mill Pond Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 9
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Pursuant to written application, permission is hereby ranted to oe Licensed Drain Layer
named herein to perfo th work i 4cate4 below at 4_
at premises-owned by whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Uther
for ----�—
occupancy or'use, with`
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE O, INDUSTRIAL
WASTES 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 Time for: Completion
Permit_ to be issued-to
the holder of Drai 'Layer'9 license' No." Permit will e2ipire `thirty`('30),'days
after date of issuance. The undersigned r�ayer `hereby agrees to all th_e terms and
conditions set forth in the permit and the reverse side thereof. Applicant 'has received
Town Permit Now , and/or 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 poli ki the name_of the Town of "Soutt 'Windsor:
Engineering Department Date
Connection Charge Paid X2 Permit Fee: Paid $
Check Number
Issued by
11 Tax dffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date