HomeMy WebLinkAboutDrain Layers Permit 133 Cambridge Drive "DIY'-T�~'I..
TOWN OF SOU :�H WINDSOR
DD B TMENT OF.�'U LIC WORKS
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RAU OF POLLU ON CONTROL
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DRAIN LAYER'S PERMIT o, 4608
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Pursuant to written application, IYermission is h reb grant d to the Lice ed Drain Layer
named herein to perform the work indicated below at /7 �},y� ` s�
at premises owned by , (j La hv 1 1 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 Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Z O Permit will expire thirty (30) days
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after date of issuance. The undersigned Drain Layer hereby agrees to all the 'terms an
conditions set forth in the permit and the reverse side thereo Applicant has receiv d
Town Permit No. and/or CHD Permit No.
Signe4
Li nsed Drain Layer
The above named Drain Layer has a valid license issuedYb! 3 , e State of Connecticut and
has filed a satisfactory bond and insurance policy }A the name aaff� the Town of South Windsor:
E gineerin Depar nt Date
Connection Charge Paid0y,90 ()(j 'IV-- _3� �� Permit Fee: Paid $
Check Number
Issued by
TaxOffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date