HomeMy WebLinkAboutDrain Layers Permit 3 Shadbush Way TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT5 3 1fi
19_y:
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by whose address 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:,,fprnish two (2) copies of separate drawings.
3!
cc1
SPECIAL CONDITIONS '
Desired Starting Date Estimated Time for Completion
Permit to be issued to ��
the holder of Drain Layer's License No. 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 ther,of. /Applicant has rft ved
Town Permit No. and/or CHD Permit No.
Signed j'�
6
i.censed brain 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 Town, of South Windsor:
Enginif6ring Depar ent Da,6e
Connection Charge Paid Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started " �- Date completed
Sufficient notification received: Y s No f
Special Conditions
APPROVED:
Inspector _pate