HomeMy WebLinkAboutDrain Layers Permit 125 Cambridge Drive it
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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNo. 4929
19 S
Pursuant to written application, permission is hereby ranted to th Licensed Dr n La er
named herein to perform the work indica d ow at ! G 4 aij
at premises owned by _ whoseddres is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
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Type of Sewage to be connected under this pebmi : ITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish'rwo (2) copie3 of separate drawings.
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SPECIAL CONDITIONS (1_Q{/�S"� 6
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License 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. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
acens d 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 jp,t name of the Town of South Windsor:
Engineeriffg Department Date
Connection Charge Paid Permit Fee: Paid $ ,� /G 1F
Check Npmber Z�
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date