HomeMy WebLinkAboutDrain Layers Permit 1105 Strong Road (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL ��yy
DRAIN LAYER'S PERMIT X2. 4962
14 _Cl , 19 4;/
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform-the work indicated below at
at remises owned b --{p y 4 �r « , rt ',r, � ) 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 d , ings.
i
- o_,.,
b
� I
SPECIAL CONDITIONS
Desired Starting Date Esti d Time for Completion
J
Permit to be issued to -,^j d -
the holder of Drain Layer's License o : Permit will expire thirty (30) days
after date of issuance. The undersigns. Drain Layer hereby agrees to all the terms and
conditions__s_et_forth in the permit and -the reverse -side thereof. p c fit has received
Town Permit No. and/or CHD Permit No. 1
Signed ✓�
Li,cen d Dra Layer
The above named Drain Layer has a valid license issued by the 'StatqVrof Connecticut and
has filed a satisfactory bond and insurance policy in the name of the 3Cown of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $
Check Number C
4 c \ .� �f� r Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date