HomeMy WebLinkAboutDrain Layers Permit 1041 Strong Road TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
O L;' 19 L-1115-
Pursuant to written application, permission is h reb garanet.0 to the Licensed Drain Layer
named herein to. perfo the wor indicated below at
at premises owned by . whose address is
and to
Lay House Drain, Repair �House Drain, Lay` in, 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
the holder of Drain .La er's_-License'No ' Permi 11_ x_i e,. hirt`_ (3Q 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 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:
EngAneqX1jtg ar De :tmen to
P
Connection Charge Paid(-/,I-?5 Permit Fee: Paid $I ;Q (�
Check Number
1 GRQ Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED; -
Inspector Date