HomeMy WebLinkAboutDrain Layers Permit 6 Shadbush Way TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S//--PERMI4
Q 5152
CP 19 d,
Pursuant to written application, permission is hereby granted to t e Licensed Drain Layer
named herein to perform the work indi ted Blow at 'I/f !l � � r,-
at premises owned by i �z� whose a dress 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
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Ti or Completion
Permit to be issued to
C-
the holder of Drain Layer's License No. - Permi ill 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.
Signed
Lice sed 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 of South Windsor:
� SPP
Engineering De went tate
Connection Charge Paid Permit Fee: Paid
Check Number
f`1 r `�A.�r �t} L( Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date