HomeMy WebLinkAboutDrain Layers Permit 8 Cornfield Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3;, 4789
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Pursuant to written application, permission is hereb granted to tJie Licensed Drain Layer
named herein to perform the work indicated below at /
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.
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to `.Sbh,rl 1 ,a M 6, (,J C.
the holder of Drain Layer's License No. Lc,,, ao5 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 received
Town Permit No. and/or CHD Permit No.
Signed
Ud r, O(A
Lic s d Drain Layer
The above named Drain Layer has a valid license i s ed by the State of Connecticut and
has filed a satisfactory bond and insurance F�pollz
'n e name of the Town of South Windsor:
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v
ngineering Departmen Date
Connection Cha ge Paid -//- 2 -L�L� Permit Fee: Paid $ �DU
�� Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
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