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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1W. 4 9 8 3
19 r�
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work,3*n Ocated bel w at � yy�_ yr_ j _.�; 7'-M2/1
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 ( ) Connection will be made with
Show sketch of propose work or furnish two (2) copies of,sepa ate drawinns_
of �` 5 g,
SPECIAL CONDITIONS
Desired Starting Date �2-01- F? Estimated Time for Completion WL)Mj-IkS
Permit to be issued to j � � 5y+ t_c �jt.15t "-) I,j
the holder of Drain Layer's License No. 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
C
Licensed rain Layer
The above named Drain Layer has a valid licens issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Z 2-
Engineelefling Department Date
c v T Z
Connection Charge Paid // G Permit Fee: Paid
Check Number �-
Issued by
Tax Office
INSPECTION
-- -- ate wor .started - - - - - -Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate