HomeMy WebLinkAboutDrain Layers Permit Wildwood Circle TOWN OF SOUTH Wl N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNO. 4850
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Pursuant to written application, permission is hereb granted to the Li jensed Drain Layer
named herein to perform the work indicated low at ��
at premises owned by ---' r 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
Show sketch of proposed work. or furnish two (2) copies of separate drawings.
G � �
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to `JoNN /� L,rnc�iQr- ?'tic
the holder of Drain Layer's License No. aed,;�ce 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
L c nsed Drain Layer
The above named Drain Layer has a valid license sued by the State of Connecticut and
has filed a satisfactory bond and insurance policy the nam f the Town of South Windsor:
Engineering DelpartmeM Date
Connection Charge Paid Permit Fee: Paid $ 1,-5-,,0
Check Number �130
Issued by
Tax Office
INSPECTION
Date work started Q j
� � Date completed a �O
Sufficient notification received: Yes No
Special Co itions
APPROVE -L
Inspector Date