HomeMy WebLinkAboutDrain Layers Permit 508 Mill Pond Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q4928
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to. perform,,the work indicated below at -Oki Z
at premises owned by whose-address is
and_ to
Lay House Drain, 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
Show sketch of proposed work or furnish two (2) copies of separate drawings. j
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion.
Permit- to be issued 'to
the holder of Drain Layer.'s -License No.. ' r' ' Permit will expire thirty (30)` 'days
after date of issuance. ' The undersigned Dra—�ifi Layer hereby agrees to alX tld tefig°`and
conditions set forth in the permit and the reverse side thereof. Applicant`has received
Town Permit No and/or.:CHD Permit No. .
Signed
Licensed Drain Layer.
The above named; Drq n, LaY.. has, a valid license issued, by the State of 'Connecticut and
has filed a satisfactory bond and insurance policy,. in the name' of the Town of` South Windsor:
Engineering Department Date
Connection Charge Paid /`t`�d.j� Permit -Fee: Paid $ ,
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate