HomeMy WebLinkAboutDrain Layers Permit 41 Oakland Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 45
-� 19
Pursuant to written application, permission is hereby granted o the Licensed Drain Layer
named herein to perform -the York indicate4 below at-
at premises owned by ;. ��, .( y- A % - whose address is
and to. :
Lay House Drain. Repair House Drain, Lay Mani, Other ,
` for occupancy or use with
Family Units, with acres.
i
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 - Estimated Time for..,Completion
Permit- to be issued to
the holder of Drain Layer's'Ilcense'No. Perthit will expire thirty' (30) "days
after date of issuance. The undersigned brain 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
ticensed'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:
Engineering Department Date
Connection Charge Paid G)cl Permit Fee: Paid
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date