HomeMy WebLinkAboutDrain Layers Permit 29 Spruce Lane wr
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ��1Jo, 4858
(� 19� I
Pursuant to written application, permission is hereby granted to the L censed Drain Layer
named herein to perform her work. 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 ermit: S tTARY SEWAOE { INDUSTRIAL
WASTES ( ),, OR ( ) 4 Connection will be made with
f,
Show sketch of proposed work or furni two�(2� copies of seps.ra.te_drawings.
/ -
! � �.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No.a d 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 ,4r,
� 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 ne name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid L; < ; J`�y (� Permit Fee: Paid $
r ` Check Number
1--�Ja- sued by
Tax Office
INSPECTION
Date work started 7J U 7 Date completed --� 7
Sufficient notification received: es No —G
Special Conditions
Or-
APPROVED*
Inspector pate