HomeMy WebLinkAboutDrain Layers Permit 1180 Strong Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT -` No. 0
Pursuant to written application, permission is hereby g ��Ggedrante to the Drain Layer
named herein to perform the work indicate below at
at premises owned by
whose address is
Lay House Drain and to
for ' Repair House Drain, Lay Main, Other ,
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under th' pe it: SANITARY SEWAGE (INDUSTRIAL
WASTES ( ), OR ( ) f/ C - Connection will be made with
Show sketch of proposed work or furnish two copies of separate drawings.
V
� t
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No i'
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 LayerY
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:
.
Engineedring.Department Date
Connection Charge Paid pj�J� "` Permit Fee: Paid $ �v
/ Check Number
Issued by
Tax Office
INSPECTION r
Date work started Date completed A
Sufficient notification received: Yes No
Special Conditions
APPROVED: -
Inspec or Date
Construction Inspection Report
Project Date
- 49
Street Time
1
Weather j In p•
( �� � .
Developer G -VA�� Contractor
Work in Progress
Problem A eas
6
Special Instructions/Orders
e