HomeMy WebLinkAboutDrain Layers Permit 80 Windy Hill Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1�No�. 42 0 I
a , 19�
Pursuant to written n a lication,' permission is erey
named herein to perfo the Tor indicated below at /g�ant ¢� to the Licen��d D ain Layer
at premises owned by ! j ; - ---` �(// �iLi ()/I /
��'^ � whose address is
Lay House Drain, Repair House Drain, La Main and to
for y , Other
Fam. Units with occupancy or use, with
y � acres..
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ),
WASTES ( ), OR ( ) INDUSTRIALConnection 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
the holder of Drain Layer's License No. Permit will expire thirty
after date of issuance. The undersigned Drain Layer hereby agrees to all the terms ands
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:
Engineering Department Date
Connection Charge Paid { � Permit Fee: Paid $
1
�;- Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date