HomeMy WebLinkAboutDrain Layers Permit 72 Oxford Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N10. 5090
qA OX-6d Of
Pursuant to written application, permission is here y granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by Ljle 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 e ), 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 IV
Desired Starting Date Estimated Time for Completion
Permit to be issued to ,4 irqa IEZLC-L" 2-bir
the holder of Drain Layer's License No. 62061-j o B 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.
i
Signed
Licen d Drain Layer
The above named Drain Layer has a valid license issu by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection w
Charge Paid ///
g �i Permit Fee: Paid
Check Number
Issued by
Tax Off is
INSPECTION
ate work started ��,L�— Date completed
ufficient notification received: _�jf"es No
pecial Conditions
APPROVED: _
Inspector 11at7e