HomeMy WebLinkAboutDrain Layers Permit 2005 Mill Pond Drive MOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o. 4.563
1/ O lg
Pursuant to written application, permission is h reby _Bra ed to the LicenO d Drain Layer ,
named herein to. perfo th work inde.Fated b low at Ljp` % g
at premises owned by 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 drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to Xe T
the holder of Drain Layer's License No. 10 s? ,1 -7 Permit will expire thirty (30) days
Y
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:
Engine ring Dep ment Date
Connection Charge Paid "1�J^1
�V � :�� Permit Fee: Paid
Check Number
c;1 ti
j U tom/ Issued by
r Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date