HomeMy WebLinkAboutDrain Layers Permit 1404 Mill Pond Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S.PERMIT o - 4405
Pursuant to written application, permission is hereb gr nted to the Licensed Drain Layer
named herein to perform the wq�rk indicated flow at !
at premises owned by
whose address is
Drain and to
Lay House , 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.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to -_ ; - /- x
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:
Engineering ,&pa
rtrM t Date
Connection Paid Charge <"
g 3C% G Per Fee: Paid $ /J� / 1
Check Number,,_ 1-/
Issued by �' J
Tax Office j
INSPECTION \
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date