HomeMy WebLinkAboutDrain Layers Permit 51 Wedgewood . TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT M1. 4939
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Pursuant to written appli tion, permission is hereby granted to the Licensed Drain Layer
named herein to performthe work indicated below at
at premises owned by .' 'E �� '.a'-, � 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 permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR,( ) Connection will be made with
�O lJ�lf
Show sketch of proposed work or furnish two (2) M Of ocyarute drawings.
37
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
i
Permit to be issued to
the holder of Drain Layer's License No. L p%Z 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 s received
Town Permit No. and/or CHD Permit No.
r
Signed
i icense Draid 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:
X, f +
Engineering Department Date
Connection Charge Paid '/ ?� ,C ` t� Permit Fee: Paid $
Check Number le)
/
Issued by
Tax Office
INSPECTION
Date work started J _
Date completed
Sufficient notification' received: Yes No
Special Conditions
APPROVED: - - 1
Inspector Date