HomeMy WebLinkAboutDrain Layers Permit 400 Oakland Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNIn'. 5027
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Pursuant to written application, permission is hereby ranted to the Licensed Drain Layer
named herein to. perform the work indicated below at ��,)lJ ' � ' �r ,
at premises owned by 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 proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 6 In Permit will expire thirty (30) days
after date of issuance. The undersigned Dr,a, ��'n L yer hereby agrees to all the terms and
conditions set forth in the permit and the' 2-1 i-rsef-side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signecj�
Licensed Drain Layer
The above named Drain Layer has a valid license of--Connecticut and
has filed a satisfactory bond and insurance policy in the name of`,the Town oft-Sb4th Windsor:
Engifneer'ii�g Department Date
Connection Charge Paid j)L Permit Fee: Paid $ /)
Check Number !;'1
12
Issued by
Tax -Of f ise
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INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date