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TOWN OF -SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
PA P
DRAIN LAYER'S PERMIT u €' 3 2 9 y
Pursuant to written application, permission is hereby g nted4o tY�e Licensed Drain Layer
IF;anamed herein to perform work indicate below at (/ ��
at premises owned by whose address is
and to
Lay House Drain, air 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 (y, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of propos rk or furnish two (2) cop �s ofl/a� drawings.
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SPECIAL CONDITIONS D �
Desired Starting Date %�N� 7 { /�� Estimated Time for Completion _T✓41F_
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire thirty (3'0) 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
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:
L Engineering Department Date
Connection C-h—a'r"gg Paid "/�L`Z` "S Permit Fee: Paid $ �� 6
Check Number
64
` L Issued by
Tax Office
INSPECTION
Date work started Date .completed
Sufficient notification received: Yes o
Special Conditions ,
APPROVED: c
46
nspector Date
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Construction Inspection Report
. Project Dole
Street " Time q ;
Weother a o In
Developer Contract r
Work in Progress
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Problem Areos
Special instructions/Orders
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