HomeMy WebLinkAboutDrain Layers Permit 52 Tallwood Drive ..
TOWN OF SOUTH WINDSOR %" "
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DEPAETHENT OF PNBtIC FgHNS ' ,.' r.
BUM OF POLLUTION CONTROL - :_ -_ _-- — -
DRAIN LAYER'S PERMIT 1-;, . 4265
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Pursuant to written pp11 Cion, permleefon fe n by g t d To pM1e,Liceneed Drain Layer
named herein to. perform th k inddcate� below at
at promisee owned by r -1':r whose addxeee ie
and t
Lay house Drain, Repair House Drain, Lay Min, Other ,
for cupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY MAPS O, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL
I CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit Co be Issued to
the holder of Drain Layer's License No. - e/ " Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereby agrees C$y1L me terms and
TOM Fermi net form m the permit and the reverse sidef//gppljaanc M1ae receives
Town tions No. and/or mit aCEDnd Permit No.
Signed
Lfe . Drain Layer
The above named Drain Layer Me a valid license issued by the Grate of Connecticut and
has filed a satisfactory bond and insurance policy in the name Of. the Town of South Windsor.
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Eng3neeiing ➢¢parCmenY ➢ate
Connection Charge Paid Pamir Fee: Paid $ i
Check Number
Issued by
Tom Office
INSPECTION
Date work started Date completed
'Sufficient notification received: Yes No
Special Conditions
AFFECTED:
Inspector Date
BBBAHLER S�g WAuJLL
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