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-TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT X0, 4642 ,
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Pursuant to written application, permission is eby gra ed to the License grain Layer
named herein to perfo the work indi to below at
at premises owned by whose addre s 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
the holder of Drain Layer's License No. o 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 -r in Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance polic - n the name of the Town of South Windsor:
. _L
Engineering'Departfient Date
Connection Charge Paid Permit Fee: Paid $ 1
Check Number
OO
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----=- Tax-_Offic-e - - -- -
INSPECTION
a e work s ar a Date comp ete
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Ins ctor Date