HomeMy WebLinkAboutDrain Layers Permit 805 Mill Pond Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT. 4161
F
Pursuant to written application, permission is he ,, ,
eby ranted tQ theiopnsed Drain Layer
named herein to perform,the,work indicated�below at '
at premises owned by G �,.,��t ur f f� whose address is
La House Drain and to
y Repair House Drain, Lay Main, Other
for
Family Units, with acres. occupancy or use, with
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.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's 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 received
Town Permit No. and/or CHD Permit No.
Signed
Licensed 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 in the name of the Town of South Windsor:
E#giftee3jing Department Date
Connection Charge Paid </l:`(1 ' -' Permit Fee: Paid $ / "; i;(1
Check Number /` '> '
/ f
i :�. i Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date