HomeMy WebLinkAboutDrain Layers Permit 7 Woodhaven Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO, 4672
19 r s
Pursuant to written application, permission is hereby granted to.;the' Lice sed Drai Layer
named herein to perfo he,work indicated below at y
at premises owned by �r .l'.GLrCEr/ 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.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to All /1,
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned-beain 17ayer 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.
Sign d
License 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:
/ r17
EngI ring Department Date
Connection Charge Paid Permit Fee: Paid $
% Check Number
Issued by
Tax Office
INSPECTION
Date work started 7-2 % 7 Date completed ]v
Sufficient notification received: Yes No
Special Conditions
APPROVED:
I ect r Gi Date
Anto Awn N C 0 STRUCTlON
BUILDERS AND DEVELOPERS
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185 SILAS DEANE HIGHWAY WETHERSFII LD,CT.06109 PHONE:(203)563-3711