HomeMy WebLinkAboutDrain Layers Permit 140 Oxford Drive / TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1�No, 5058
�C) ox;,d, Or
J—J/ 19
Pursuant to written application, permission is hereby grant=toL' e e Drain Layer
named herein to perform t w k indicated below at
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
NobSe. �
Show sketch of proposed wo or furnish two (2) copies o separate drawings.
All
ry►,N ec:.�d u
�d
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to ' ) , , A Li�tr��,eGeri lHc.
the holder of Drain Layer's License No. ,-)Loz,;joe 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 Qj �,,A
Lic sed Drain Layer
The above named Drain Layer has a valid license iss d by the State of Connecticut and
has filed a satisfactory bond and insurance policy in th name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid o Permit Fee: Paid $ �
Check Number
1
Issued by
Tax Office
INSPECTION
Date work started -�<f— Date completed `�—c9eq
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date