HomeMy WebLinkAboutDrain Layers Permit 43 Oxbow Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL Q
DRAIN LAYER'S PERMIT 3 3712�
43 aboo
19 —
Pursuant to written application, permission is ere y granted to the icensed Drain Layer
named herein to perf� the w rk ind ted a ow t
at premises owned b (� 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.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit- to be issued to
the holder of Drain Layer's -License No. Permit will expire thirty (30)-'days
after date of issuance. The undersigned Drams 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
Lieensed' 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 name of th Town of South Windsor:
Engineering' Deparrtment Date
Connection Charge Paid 6-V-05 .& Permit Fee: Paid $` _ 0 �1
Check Number 1 j 6
Issued by
Tax 6ffice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
I L
�- Date
-.