HomeMy WebLinkAboutDrain Layers Permit 2004 Mill Pond Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ®, 4562
7 19ff�
Pursuant to written application, permission is ereby gr nted' t the Li ensed Drain Layer
named herein to perfo t e work di cat d below at �o6� �P�
[�
at premises owned by f 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 An
the holder of Drain Layer's License No. ,2o?,2 ./3, `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.
i
i
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-gf the Town of South Windsor:
-En ineer ng Depart nt gate
i �� o Permit Fee: Paid $ J y J
Connection Charge Paid�`�!F / � �� �
Check Number
12 i3O_.A_,i / ) i`-L Issued by
Tax 'ffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date