HomeMy WebLinkAboutDrain Layers Permit 111 Oxford Drive _ TOWN OF SOUTH WIN DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5 410
19�
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at Ox-PO, d -95fa+@S --U 1S
at premises owned by U k e Cc,,, whose address is
and to
Lay House Drain, ,/ Repair House Drain, Lay Main, Other ,
for in I e -re 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
6 - pvc.
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECI•AL CONDITIONS Q r�or�(
Desired Starting Date ASAP Estimated Time for Completion 1 Q
Permit to be issued to �o{ (� L�,h b 2r'�1 er Jh c,
the holder of Drain Layer's License No. ,Zos 416 JPermit 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
ensed Drain Layer
The above named Drain Layer has a valid license Tiued by t e 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 Charge Paid Permit Fee: Paid $ I 06
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: es No
Special Conditions
APPROVED,` r
Inspector pate