HomeMy WebLinkAboutDrain Layers Permit 16 Victor Lane TOWN OF SOUTH WI N DSOR
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DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NXY 39$2
19as
Pursuant to written application, permission is here grant d t th L'cens ra Layer
named herein to perform the k: ind'ca d b ow at
at premises owned .by hose address is
and to
Lay House Drain, 'Repair Ouse 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
Show sketch of propooed. work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting-Date Estimated Time for Completion
Permit. to be issued to
the holddr of Drain Layer',s License No Permit will expire thirty ( 0)�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 -Connectcut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
- .Engineering Department Date
Connection C e Paid' / �ldr-r Permit Fee: Paid $7-11T
Check Number -
Issued by
Tax office
r
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date