HomeMy WebLinkAboutDrain Layers Permit 044 Cambridge Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NN2, 4772
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Pursuant to written application, permission is .herebv,grante to the Licensed Drain Laver
I / , 4"
named herein to perform the work indicated below at 7 - .( ;.
at premises owned by
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 627d_n
the- holder of Drain Layer's License No. -2-0 sl_u 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 Q-eived
Town Permit No. and/or CHD Permit No.
Signed
tensed Drain L
P_ er
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:
En6finee-ritrg Department Date
Connection Charge Paid Permit Fee: Paid $ ()O
Check Number
114 Issued by
Tax Office
INSPECTION
Date work started -7 1 0- Date completed
Sufficient notification kereived: "Yes No
Special Conditions
APPROVED:
Inspector 'Date