HomeMy WebLinkAboutDrain Layers Permit 402 Mill Pond Drive (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
y DRAIN LAYER'S PERMIT
3998
Pursuant to written application, permission is he by rant d .t th Licensed Drain Layer
named herein to perfo the work i caged helo at 6
at premises;owned. by whose address is
_ and to
Lay House Drain,' Repair Hou a Drain, _T Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWACE ( ), INDUSTRIAL
WASTES ( ), OR Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
z.�
SPECIAL CONDITIONS
Desired Start'in.g Date _ Estimated Time for Completion
Permit. to -be issued to
the holder of Drain`iiayer's I cerise No. - Permit will expire thirty` r30) "days
after date of issuance. The undersigned Dra� in"Layex hereby agrees to ail th `terms'.'and
condition's set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. .. ,.y :and/or CHD Permit No.+ .
Signed"
Licensed Drain Layer
The above named Drain Layer has 'a valid license issued by the gtate of Connecticut and
has filed a satisfactory bond and insurance palicy. ' t name of the.Town of South`Windsor:
gineering Depart en.t -Date
Connection Char a Paid t!v• }`
g �� (� Permit Fee: Paid $ A az)
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date