HomeMy WebLinkAboutDrain Layers Permit 10 Pepperbush Way TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19
Pursuant to written application, permission is hereby grante to th Licensed Drain Layer
named herein to perform the work indicated below at (l�
at premises owned b
y whose address is
La House Drain and to
3' , Repair House Drain, Lay Main ,for , 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 'me for Completion
Permit to be issued to
the holder of Drain Layer's License No. G
r it 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 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:
Engine ng Department Date
Connection Charge Paid
Permit Fee: Paid
J •
Check Number
it-t'- l _�/f-j'2• �L Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date