HomeMy WebLinkAboutDrain Layers Permit 277-297 Oakland Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNti, 4900
19 ,/
Pursuant to written application, permission is hereby granted, to the Licensed Drain Layer
named herein to perform the wprk indicated below at _�a 64
remises owned b
P Y
at % � ,{ —�
� � �; ;;whose address isIM �
q Zc bt ll) 1 Jc)krx-0 ,64�0�e_ C-{- and to
Lay House Drain, oaf'' Repair House Drain, Lay Main, Other ,
for i,` +) 1' i� l r ,A 1f ` ` "\t, T17'L . occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (V), 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 -bi Estimated Time for Completion p7bfvTc
Permit to be issued to P )
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. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed l
Li c ns d 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 e of the Town of South Windsor:
ng veering Department Date
Connection Charge Paid /, UIJ v�.) Permit Fee: Paid $ J
Check Number
I,ssued by
- Tax office
INSPECTION
- --__ Date work started Date completed
-ent notification received: Yes No
Conditions
APPROVED:
Inspector Date