HomeMy WebLinkAboutDrain Layers Permit South Windsor High S (2) all TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT5 6 9
j Z , 19 /
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform he work indicated below at e, < �� r�
at premises owned by G A-) Or. whose d dress is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
FamilyUnits 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.
SPECIAL CONDITIONS
Desired Starting Date /�;�- r , __ � Estimated Time for Completion
r �z2
Permit to be issued to �o./i 0 - ,
the holder of Drain Layer's License No. .2 r) 3 a . Permit will expire thirty 30) days
after date of issuance. The undersigned Drain ayer 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 Drain 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 in the name of the Town of South Windsor:
Engine g Department Date
Connection Charge Paid \ I //r
g � " P it Fee: Paid $ AJ a AJ Cam'
C ec Number A
r
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
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