HomeMy WebLinkAboutDrain Layers Permit 109 Cambridge Drive Sr- %mr
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL ��TT
DRAIN LAYER'S PERMIT MD. 4797
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J 19 - 1
Pursuant to written application, permission is h reby granted the Lic sed , rain Layer
named herein to perform the �ork in ica a below at (� - st p
I at premises owned by who e 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 pe i : SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) 11 Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
�°
SPECIAL CONDITIONS CAoM, '!G c. D/e, 4-1 T`;
Desired Starting Date Estimated Time for Completion
Permit to be issued to 1114
the holder of Drain Layer's License No. 2+0 7%. 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
icensed Drain er
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance poli n he name of the Town of South Windsor:
Engineering Department Date
Connection Charge J
g � � � / 7 � � Permit Fee: Paid $
Paid Check Number
V, 1 ssued by
6vTax off is
INSPECTION
Date work started 4- Date completed
Sufficient notification received: Yes No
Special Conditions
Inspector Date