HomeMy WebLinkAboutDrain Layers Permit 133 Cambridge Drive (3) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN: LAYER'S PERMIT (_ 5 '164
Pursuant to written application, v
Pp , permission is hereby granted to the icens d Drain Layer',
named herein to..perform the work indic�a ed be' ow a � -.� /
at premises owned by address is
La House Drain and to
y , Repair House Drain, Lay Main, Other
for
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( )
Connection willlbe 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. Permit will expire thirty (36) 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.
G-7
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:
Engineering Department Date
e vU
Connection Charge Paid Permit Fee: Paid $ �5
717 3 X7
Check Number 171
r
Issued by
Tax Office
INSPECTION
Date work started .
Sufficient notification received: Date completed
�Yes No
special Conditions
I APPROVED:
Inspector pat