HomeMy WebLinkAboutDrain Layers Permit 100 Oxford Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 2 5175
Pursuant to written application, permission is hereby Aranted to the 'ce sed Dr in Layer
named herein to perform the work indipated below at
at premises owned by -Gr - .- ose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for �' , � occupancy or use, with
Family Units, with c7 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 ,'ate ra
Permit to be issued to
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. Cal and/or CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a valid license issued 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 ate
Connection Charge Paid — Permit Fee: Paid $ %J•/�d !
Check Num
Issued by '
. Tax Office J
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date