HomeMy WebLinkAbout101 Oakland Rd - Drain Layer Permit (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by C 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 w urnish two (2) copies of separate drawings.
Hof
SPECIAL CONDITIONS ---- --
Desired Starting Date Estimated Time for Completion
Permit to be issued to :J L u <"
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. Applican s r;O-ceived
Town Permit No. and/or CHD Permit No.
Signed i (J
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State kf='Connecticut and
has filed a satisfactory bond and insurance policy! in the name o he Town of South Windsor:
En�inee�i Department Date
Connection Charge Paid ? c� - Permit Fee: Paid $ 1
heck Number
Issued by ---j C
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date