HomeMy WebLinkAboutDrain Layers Permit 502 Mill Pond Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT _ 4922
;?v✓; � /�/ 19
Pursuant to written application, permission is hereby granted to the Lif�ensed Drain Layer
named herein to .perform-,the.work indicated below at �(} } / ✓�'Ki 'tlf ��
at premises owned- by whose address is
and to . •
Lay House Diain, 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 O, OR O Connection will be made with
Show sketch of proposed work $r furnish two (2) copies of separate drawings.
i
SPECIAL CONDITIONS :
Desired Starting Date Estimated Time for Completion
Permit- to ba issued t4 '
the holder of DrainT,ayer`$ License No. ;_ permit will expire thirty (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'ieceived
Town Permit No: r.:,, andlor EHD .Permit No.
Signed
Licensed Drain.Layeto
The above named brain Layer has a .valid license 'issued by the State of Conhecticut and
has filed a satisfactory bona and'i.nsarance policy. in the name of the town of Souti :Windsor:
Engineering Department. Date
Connection Charge Pad 6 0,6 i Permit Fee: Paid $
Check Number
Issued by
Tax a fice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date