HomeMy WebLinkAboutDrain Layers Permit 22 Arrowwood Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNOo 4917
-- 19G�
Pursuant to written application, permission is hereby ranted to.the icesed Drain Laye
named herein to perfo . he work indica e ' below at l
at premises owned by
` whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
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 Estimated Time for Completion
Permit to be issued to �--
the holder of Drain Layer's License No n 2
��� � - . 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. _
Signed `
Licen d 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 Town of South Windsor:
5)
Engineering Department Date
n
Connection Charge Paid file Permit Fee: Paid $
` Check Number
Issued by .4A i �S
Tax Office
t
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date