HomeMy WebLinkAboutDrain Layers Permit 02 Arrowwood Circle (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERM T 9. 4919
641
192-1
Pursuant to written application, permission is h eby ra
named herein to perfgx ted Po the/Licensed Drain Layer
,m the!work indica ed} below at y
at premises owned by -� it {, ' �
+� whose address is
and to
Lay House Drain, Repair House Drain, La Main
for y , Other ,
Famil Units, with occupancy or use, with
y 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 Time for Completion
Permit to be issued to r
the holder of Drain Layer s T,rAntO No. 27�5� 7. Permit will expire thirty
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
License ain 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:
r
Engineering Department Date
Connection Charge Paid `
g Permit Fee: Paid
Ceck Number
U �- _.. Issued by
/1 Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date