HomeMy WebLinkAboutDrain Layers Permit 32 Cornfield Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT jp, 4662
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Pursuant to written application, permission is hereby ante ,//t�oy�the Licensed Drain Layer
named herein to perform the work indicated be ow at _3 G v"GP I<1V
at premises owned by whose address 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 of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date 9 Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No.2c;(.. zc.F_ 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 per nd the reverse side thereof. Applicant has received
Town Permit No. HD Permit No.
Signedop i
//I Lice7Sate
d Drain Layer
The above named Drain Layer has a valid license i ued by the of Connecticut and
has filed a satisfactory bond and insurance policy in t e name rothe Town of South Windsor:
- Engifieering Departme Date
Connection Charge Paid 2T _S 7 Permit Fee: Paid $ /S Y
Check Num. _ -7/1
Issued by
(_ Tax Office �
INSPECTION
Date work started Date completed
Sufficient notification eceived: Yes No _
Special Conditions
APPROVED:(
Inspector Date