HomeMy WebLinkAboutDrain Layers Permit 9 Summerwind TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WONI(S
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 54F
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Pursuant to written application, permission Is hereby granted to t lie �rain Layer
named herein [a. perform the work Indicated below at 'epae
at p[emlaee owned by wM1oee address fa
e and to
S
Lay House Drain. // Repair House ➢rain. Ley Main. Other
for cupancy ax uea. with
Family Dnita, With ree. � /
Type of Sewage to be connected under this permit: SANITARY ARCANE If. 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 /O Estimated Time for Completion
Permit to be issued to Ca/v� iu� FF
the Holder of Drain Layer's Liceuee No. .Rf��/ 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 r aide thereof. Applicant has received
Town Permit No. and/or CID) Permit No.
Signed ..z�
L4ceneed Dx a
The above named Dtain 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 Tom of South Windsor
5 � Engineering Depaxtme¢e
3- U
Connection charge Paid � Permit sae: Pais
Check Number
Issued by
Tax office
INSPECTION
Date work started Date completed
Sufficient notification received: Yee No
Special Conditions
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APPROVED: Pate at¢