HomeMy WebLinkAboutDrain Layers Permit 41 Karen Way TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNI,o,. 4 8 S 8
Pursuant to written application, #ermission is hereby granted to the Licensed Drain Layer
named herein to perform the wprk_ indicated below at
at premises owned by � + 1
chose address is
Lay House Drain, Repair House Drain, La Main and to
for y , Other ,
Family Units, with acres occupancy or use, with
.
Type of Sewage to be connected and
OR
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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L/57 0
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SPECIAL CONDITIONS L"Rc7� `!-,4,Y 0 f9
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 2--7 � "� Permit will expire thirty (30) days
after date of issuance. The undersigne Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side the eof. Applicant has received
Town Permit No, and/or CHD Permit No.
Signed
Licensed rain Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy the nam of the Town of South Windsor:
EngineerNing Depa ment Date
Connection Charge Paid Permit Fee: Paid
$
Check Number
Issued by
Tax Office
INSPECTION
Date work started / '
`� Date
--Su€f-ieient-notificat Ion
-received: Yes
- -
- -
Special Conditions No
--- - APPROVED:
Inspector Date