HomeMy WebLinkAboutDrain Layers Permit 701 Mill Pond Drive TOWN OF SOUTH WI N DSOR
to- DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
3110 , 19
Pursuant to written application, permission is her by &r ted to the Licensed Drain Layer
named herein to perform the work- indicat below at (/
at premises owned: by 1,496f 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 'drawi '
SPECIAL CONDITIONS
Desired Start3.ng Date Estimated Time..for.- Completion
,
Permit_ to be issued`to'
the holder of Drain Layer's"-L'icense,No'.. Permit' will. expire thirty "(30)` days
after date of issuance. ' The undersigned Drain Layer hereby agrees to all the ter6i 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: Drain L•ayer'has a valid license issued by the M` ate of'Connecticut and
has filed a satisfactory; bond and insurance. policy in iie name of``the Town of'`South;Windsor:
r. .
Engineering Department:, Date
Connection Charge Paid ' 3he/,% Permit Fees Paid $ 3 0'
Check Numb r
{L' Issued by, C'
C Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date