HomeMy WebLinkAboutDrain Layers Permit 1575 Main Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS-
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4187
No
-T
5
Pursuant to written application, permission is hereb h icensed Drain Layer
y granted_ to t
named herein to perform th - ork ipdicated b low at
at premises owned by 1111 . _ J �7, whose address is
V 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.
Desired Starting Date Estimated Time for Completion
Permit to be issued to
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
Lieitrsed Dvain,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 *n the name of the To of South Windsor:
Came
Engineering Department Date
-:-!7-
Connection Charge Paid Permit Fee: Paid $ /S j /��
Check Number
Issued by
Tax Office
INSPECTION
Date wok started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date