HomeMy WebLinkAboutDrain Layers Permit 4 Tumblebrook Drive TOWN OF SOUTH W1 k DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3927
CAL 42�— - 19L�—
Pursuant to written application, permission is hereby�grante oBWT
s Drain Layer
named herein to.perform the work indicated below at :�
at premises owned by = whose address is
and to.
Lay House Drain, Reps.ir House`Drain; : Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under thi permit: SANITARY SEWAGE , INDUSTRIAL
WASTES ( ), OR O 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 foompletion
Permit_ to `be issued to
the holder of Dram} Layer's_Ticense_,No. . Permit will expire thirty`"(30)',days
after date of issuance. )The undersign Dra n Layer her 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 i name g the Town of South Windsor:
y,Cr 4S'`
Engineering Department Date
Connection Charge Paid �(��`�,�j-t�.J del Permit Fee: Paid' $
Check Number
,
�U Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate