HomeMy WebLinkAboutDrain Layers Permit 116 Concord Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
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DRAIN LAYER'S PERMITSo. 4798
Pursuant to written application, permission is hereby gragted to the Licensed Drain Layer
named herein to perform the ork in icate4 bel9w at
at premises owned by f;= whose address is
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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 41cl-oj;
the holder of Drain Layer's License Permit will expire thirty (30) days
after date of issuance. The undersigned D=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.
Signed j
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,Ifbe name of the Town of South Windsor
-
-Engineering 1Department Date
Connection Charge Paid ; r ` � ' �` + -. Permit Fee: Paid
Check Number
C Issued by
Tax 6ffice
INSPECTION
Date work started Date completed '7 77 9/
Sufficient notificati eceived: Yes No 1
Special Conditions - _/alz
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APPROVED:
Insp ctor . ate
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