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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
_DRAIN LAYER'S PERMIT
DATE: 9 9S
Pursuant to written appl/cati n, permission is hereby granted to the Licensed Drain Layer Mimed herein to
perform work at f l�.r%+� "t a t- , Lot#_as indicated be%w,-at
premises owned by 4,JC o9y# eon s t whose address is r1d,.rr/�✓ � and
to Lay House Drain Repair House Drain , Lay Main Other , for
occupancy or use, with 'acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGEW, INDUSTRIAL WASTES(1,
OR;,f 1 Connection MY be made with Al/
work to be in accordance with Town of South Windsor standards, a//OSHA"requirements and the conditions
indicated on the back of this permit.
Proposed start date 9?5 Estimated time for completion Ve
. Permit is to be issued to »t or • or I the holder of Drain Layer's License No.
. Only holders of P1, P7 & W9 licensei will b issued permit. Permit w/1l expire thirty <30J
days aher date of issuance. The undersigned Drain Layer hereby agrees to all the terms and condXonsset
forth in the permit and the reverse side thereof. Applicant has received Town Street F.Xcf$iedon Permit No.
.21 and/or ConnDOT Permit No. a
Signed_ Al
LI ensed 9po Layer
FOR TOWN USE Oft Y
Permit Fee Paid $ (Check No.)
Y N Connection Charge $ (Receipt No.) Date
Insurance on File ( 1
Bond on File ) ( 1 This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on file,svdsfactvey bond
Premises subject to and insurance in the name of the Town of South Windsor.
intertown Agreement ( I f l
Record of Sewer /Z
q'
Assessment ( 1 l 1 Issued b Date
Date Work Started Date Completed`
- mmen. _
APPROVED:
Inspector Date