HomeMy WebLinkAboutDrain Layers Permit 6 Pepperbush Way TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT j
b t$s
19 d�)�'--
Pursuant to written application, permission is hereb granted to the Licensed Drain Layer
named. herein to perform the work indica ed below at
at premises owned by _; i�;. .,c��. ; , � L whose address is
Lay House Drain, Repair. House Drain, Lay Main, and to
for 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 Ti for Completion
Permit to be issued to
the holder of Drain Layer's License No. Perm' 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
Licensed 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:
Engineer)g Department Date
Connection Charge Paid /MV Do Permit Fee: Paid $ Gy
Check Number 2
ri•'Gf(c_ < L�t- Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate