HomeMy WebLinkAboutDrain Layers Permit 8 Pepperbush Way TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT * 5313
Pursuant to written application, permission is hereby granted, to the Licens d Drain Layer
named herein to perform the work #dicated below at � %
at premises owned by '-�.'r ,c i; ) ,* f =;;�Lt,cp�u U whose add ess 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 furnish two (2) copies f separate,=drawings.
71 f
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued ( Gp
the holder of Drain Layer's Licen a No. 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. Applicanj, has .rec-eived
Town Permit No. _ and/or CHD Permit No. / !
SigneC>- -•�.
L icens 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 To of South Windsor:
En eering Depamffent Date
Connection Charge Paid Permit Fee: Paid $ 0
- Check Number l( ;
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
Of oe
APPROVED: P
Inspector Date