HomeMy WebLinkAboutDrain Layers Permit 1406 Mill Pond Drive TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT No.r 4407
f
Pursuant to written application, permission is he ed t
reb gr o the Licensed Drain Layer
named herein to perform the work indicated below at Y U
at premises owned by `� s
whose address is
La House Drain and to
3' 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 Xl)' j" / ,a;;
the holder of Drain Layer's License No. _� , 4 7 y (30) days
xa i Permit will expire thirt
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:
/Z
Engineering Department Date
Connection Charge Paid ' -cq- Permit Fee: Paid $ Zj e- C
Check Number
l�../
1 Issued by
Tax Otfise
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date