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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT jTe. 4375
._ 19 '
Pursuant to written application, permission is hereby granted" o the icensed Drain Layer
named herein to perform rthe wprC ind'cated low 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 { ) w Connection r11 be made with
r� VC-
Show sketch of proposed work or furnish two (2) copies of separate drawings.
\ t
SPECIAL CONDITIONS 07-6
Desired Starting Date — Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No.7.2/ t a/rdj 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
Licensed D in Layer
The above named Drain Layer has a valid license iss ed by the State of Connecticut and
,.. a
has filed a satisfactory bond and insurance policy i name of the Town of South Windsor:
C
Engineering Department Date
Connection Charge Paid / j) G lJ Permit Fee: Paid $
-� Check Number 6�2 b
Issued by
Tax 6ffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date