HomeMy WebLinkAboutDrain Layers Permit 434 Oakland Road MPI
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
r _— .a e^ 5 3 �.
DRAIN LAYER'S PERMIT P- -- ---- �----._._._ �,� r. $
Pursuant to written application, permission is hereb— nted to the Licensed Drain Layer
named herein to perform the work indicated, below at
at premises owned by 't� a ,� f ,•F ;;%!% whose address is
S
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for Cs- A . occupancy or use, with
Family Units, w2th 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.
I
�j
SPECIAL CONDITIONS t7_ ..__
g1 z8�8� oCe �!
Desired Starting Date i `; Esti ated Tie for Completion 15,4
Permit to be issued Y
the holder of Drain Layer's License No. Z V T?1 C . Permit will expire thirty (30) days
Y
after date of issuance. The undersigned Drain Layer hereby agrees toIt4-
4i 1 t terms and
conditions set forth in the permit and the reverse side thereof. 1ant as received
Town Permit No. and/or CHD Permit No. '/
Signed , ✓
cense �ain 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 name of the Town of South Windsor:
noinei ,Department Date
er'n�_
Connection Charge Paid Perm# Fee: Paid $
i,Check Number
Issued by �+
Tax Office
INSPECTION !_
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date