HomeMy WebLinkAboutDrain Layers Permit 31 Victor Lane TOWN OF SOUTH WI N DSOR
/ DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19_j�
Pursuant to written application, permission is her by granted to the Li ensed Drain Layer
named herein to perform the work ind' ated) below at
at premises;owned by
� whose address is�y +� and to
Lay House Drain, Repair House Drain, ' La Main, Other
for y ,
Family Units, with acres. occupancy or use, with
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 e s Estimated Time for Completion y�
Permit to be issued to
the holder of Drain Layer's License No. Z-o P%S Z_o Permit will expire thirty (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.
f
Signed
Licensed Drain Layer
The above named Drain Layer has a valid license i sued by the tate of Connecticut and
has filed a satisfactory bond and insurance policyr)in Sued
name ; e Town of South Windsor:
Engineer Department Date
Connection Charge Paid / ;permit Fee: Paid $
Checkfumber G' j
Tax Qf f ice Issued by
INSPECTION
Date work started Date completed 7-
Sufficient notification received: s No
Special Conditions
APPROV
Inspector pate