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TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3847
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Pursuant to written application, permission is h by gr me to the Li ensed Drain Layer
named herein to perfo the wo • indic ted, be ow at
at premises owned :by juwhose address is
and to
Lay House Drain, ` Reph.ir 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
II
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 :: x
the holder of Drain Layer!s.-Lic"ense'No'. ." .Permit will expire `thirty (30) `days
after date of issuance. The undersigned Drairi Layer hereby agrees to, all. the tertus;'and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No.. arxd/or__,CID Permit No..
Signed r i
Licensed-Drain Layer
The above named Drain Layer has. a valid license issued by the State of `.Coritie#icut and
has filed a satisfactory bond, and insurance policy,.in the name of `.the`Town of South Windsor:
ine rirDepartment: gate
Connection Charge PaidQ 9
g l-��'��9�] Permit Fee: Paid $ / _T
Check Number
Issued by'
Tax ffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date