HomeMy WebLinkAboutDrain Layers Permit 133 Oxford Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5215
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Pursuant to written application, permission is hereby gran ed to th� License Drain Layer
named herein to. perform the work indicated below at ,� l�
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.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to Qj--, J,�
the holder of Drain Layer's Licenpf'No. ,,,206&06 Permit will expire thirty (30) days
Y
after date of issuance. The and r igned Drain Myer 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
Lic ed Drain Layer
The above named Drain Layer has a valid license i s ed by the tate of Connecticut and
has filed a satisfactory bond and insurance policy i t e name of the Town of South Windsor:
Engineering Department Date
Connection"Charge Paid � Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
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