HomeMy WebLinkAboutDrain Layers Permit 74 Windy Hill Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYERS PERMIT y ;)
r1q � 19-0
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Pursuant to written appli tion, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by f /;. :�_s whose address is
If is tiJf - r.
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for 1 �. - 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 of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion Zf
Permit to be issued to
the holder of Drain Layer's License No.�< c IiE 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
Lid nsed 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:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started r�� r " Date completed
Sufficient notification received: _1G Yes No
Special Conditions
- APPROVED
Inspector~ Date