HomeMy WebLinkAboutDrain Layers Permit 2207 Mill Pond Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITo, 4621
19SZ�
Pursuant to written application, permission isjxreby gra ted to he i nsed Drain Layer
named herein n dby t work i dicated below at premises owned by � �` ��
L` whose address is
Lay House Drain, Repair House Drain, and to
for and
Main, Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE WASTES ( ), OR ( ) ( ), INDUSTRIAL
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 wilafter date of issuance. The undersigned Drain Layer hereby agreesxtorallh the yterms ands
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 Department Date
Connection Charge Paid �-'3,$���3
Permit Fee: Paid $ (�
Check Number
�l 1-LJ2�
Issued by
Tax of ice
INSPECTION
Date work started
Sufficient notific ation received: Date completed
Yes No
Special Conditions
APPROVED:
Inspector pate