HomeMy WebLinkAboutDrain Layers Permit 011 Cambridge Drive (2) TOWN E OF SOUTO WI N DSOR
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DEPARTMENT OF PUBIC WORKS
BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT Vol. 4606
d` 19
Pursuant to written applicafton, permission is hereby granted tor, the Licensed Dr)ain Layer
named herein to perform the work indicate¢ below at S� � !z
at premises owned by }j�.,(,L�� r=, tc; ��� whose address is
and to
Lay House Drain, Repair use 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. ZO g Z9 3. 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 re ived
Town Permit No. and/or CHD Permit No.
Signed
Ylerased Drain L
The above named Drain Layer has a valid license issued by. the State of Connecticut and
has filed a satisfactory bond and insurance p(?l'cy in the name the Town of South Windsor:
�
Eigineerin epar ent Date
1
Connection Charge Paid J/("'U C)L) Permit Fee: Paid $ p"i tJ�/
Check Number
.,1
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date