HomeMy WebLinkAboutDrain Layers Permit 509 Mill Pond Drive .-' 70 'J r. .t '...... .� ..
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �'J
,-,, Pursuant to written application, permission is hereby granted to the nsed Drain Layer
named herein to .perform� d'he work incated below at �Q 9 � y .
at premises owned by Yjgj Ajd1Jw a , whose address is
and to .
Lay House rain, ` Repair House Drain, 'Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) - Connection will be made with
C
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 Draift La.yer's -License. N4'. `: Permit will expire,thiirty (30)' days
after date of issuance. The undersigned Drain 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/or CHD Permit No.
S i'gned
Lieense& 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_an the name of the Town of,'SouCh Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee, Paid $
Check Number
Coll G i,(; Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date