HomeMy WebLinkAboutDrain Layers Permit 1200 Strong Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT X0, 4400
40 S-IrDn of 19
Pursuant to written application, ermission is her b &r nted o the Licen d Drain Layer
named herein to perform th work indicated below at ,� /�,,((/J
at premises owned by 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�lDLj),
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_will-expire thir-ty-(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
"a-
nd-ed 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 rge Paid yov Z(XU Permit Fee: Paid $ �S-� q Aw h,
Check Number 2 .Z o L-
Issued by
Tax Office
r`
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No -�
Special Conditions
-- -- --- APPROVED: --
Inspector Date