HomeMy WebLinkAbout101 Oakland Rd - Drain Layer Permit TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5 3 h '
Pursuant to written application, permission is hereby gra ted to the Licensed Drain Layer
named herein to perform the work indicated below at /^T_(�ft��%r'?��J 120
at premises owned by � , 6 Jr „ whose address is
and to
Lay House Drain, Repair_ House Drain, Lay Main, Other ,
for / 14"I't _a) r 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 A furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date 0 Estimated Time for Completion
Permit to be issued to ��j(/(—A r
the holder of Drain Layer's License No. . aU 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 ,AggT'*ca has received
Town Permit No. and/or CHD Permit No. Z
X(Signed i '`
Lice 'r�in Layer
The above named Drain Layer has a valid' licen a issued by th tate of Connecticut and
has filed a satisfactory bond and insurance policy in the na a of they o�an of South Windsor:
E gineer g Dep - tment Date
Connection Charge Paid- (erCv
g 't Fee: Paid $
Check umber � \C2
Issued by
�
Tax Office J (�
INSPECTION _
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
' Inspector Date