HomeMy WebLinkAboutDrain Layers Permit 077 Cambridge Drive v .
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT o, 47
9 6
19i]
Pursuant to writtenapplication, permission is h reb gr-,ted to the,;_Lice sed Irain Layer
named herein to erfo the work Indic tied below at ,r
at premises owned by - who 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.
!� (44
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's Licens No. Z p ?_q 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 thereo Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Dra' ayer
The above named Drain Layer has a valid license 1sued by the State of Connecticut and
has filed a satisfactory bond and insurance policy `the name of the Town of South Windsor:
y! % -7
i l
ngineering Department Date
Connection Charge Paid "/`j (� ,#3 Permit Fee: Paid $
/ Check Number /y
by
Tax Office
INSPECTION )
Date work started rJ T (/ Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED,:---.
Inspectot Date