HomeMy WebLinkAboutDrain Layers Permit 160 Oxford Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
VNt , � BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5353
c (I D ecT- 19 J,-q
Pursuant to written application, permission is hereby granted to the Licensed; in/ n Layer
named herein to perform the work indicated below at nx FOeo �S /6 T�
at premises owned by C whose address is
HA W r H4i uc-HesrFlt CT-, and to
Lay House Drain, y Repair House Drain, Lay Main, Other ,
for t I-,4rr(«I occupancy or use, with
Family Units, with I acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (vY INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
ti"Fly c
Show sketch of proposed work or furnish two (2) copies of separate drawings.
T�
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SPECIAL CONDITIONS
Desired Starting Date P�P Estimated Time for Completion l�Av
Permit to be issued to JQ+4" A L iM n Eye c c-2 Z�uc
the holder of Drain Layer's License No. 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
Licen d Drain Layer
f
The above named Drain Layer has a valid license iss a by the State of Connecticut and
has filed a satisfactory bond and insurance policy in the nam of the To f South Windsor:
En in r g-Dtpa t Date
Connection Charge Paid 3 02 erm' F aid $
heck mber
Issued by
Tax Office �
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date