HomeMy WebLinkAboutDrain Layers Permit 277-897 Oakland Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Nino. 4933
6
Pursuant to written application, permission is hereby ,granted Ito„the Licensed Drain Layer
named herein to. perfpx-m the work-indicated be o at t, % J-4
at premises owned by4 , H-0se ddre is
iAi' f and to
Lay House D rain, . Repair Hous Drai , Lay Main, Other ,
for _��j'1- ,,t1A!_ ( >rY1 r+;-�F C,if? _ � �*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 or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date - Estimated Time for Completion
Permit to be issued to T
the holder of Drain Layer's License No, Permit will expi e 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 thereo Applica 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 t name of the Town of South Windsor:
Z1 ,2~yz
ngineering,Department Date
Connection Charge Paid L,-- U %jam ;` t,r 7 Permit Fee: Paid
Check Number
`—Y(__.�. �? l� Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED•
Inspector Date