HomeMy WebLinkAboutDrain Layers Permit 510 Mill Pond Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT No 4030
J',d /y , 19 dA
Pursuant to written application, permission is hereby granted t the Li ensed Drain Layer
named herein to ,perform,�the ork .ind'cated below<at �`./b (�}yt
at premise's dwn.ed by r ,
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 ( ) Connect-ion will be made with
Show sketch of proposed work'or furnish two' (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated :T me for Completion
Permit_ to be issued to
the holder of Drain Layers'"License No: Pertiit will expire'thirty' (3a) "days
after date of issuance. The" undersigned Drain Layer hereby agrees to all _the texms`;and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No-. and/or-- CH_D ,Permit No.
r . 'Signed
Lic'ei#s'ed Drain:Layer
The above named Drain Layer has-. a {valid license issued by the State of "Connecticut and
has filed a satisfactory bQnd. and insurance policy in 'the name ,of the Town of 'South Windsor:
Engineering :Department- Date
Connection Charge Paid '//A0 d y "permit Fee: Paid`$ 6*9
Check Number
a Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate