HomeMy WebLinkAboutDrain Layers Permit 15 Woodhaven Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT b, 4671
Pursuant to writt application, permission is hereby granted to the Licensed Drain Layer
named herein to perform e wVk indicated below at `" #/�� ,7,� 1� ��y �i; yam; 6, p- P�-�
at premises owned by whose address is
and to
Lay House Drain, Rep 'b. House Drain, Lay Main, Other ,
for r 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 ,E, A-z, f c-� 1 ,wC
the holder of Drain Layer's License No. G - 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
Licensed Drain Layer
The above named;&rain 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:
' 7 7
Engineering De-pdjkment Date
Connection Charge Paid Permit Fee: Paid $ QtJ
Check Number
�T
Issued by
" Tax Office
INSPECTION
Date work started 7`2 7 8? Date completed 7—
Sufficient notification received: 1/' Yes No
Special Conditions
APPROVED:
�� Inspector Date
CO.
CONSTRUCT/ON-.
BUILDERS AND DEVELOPERS
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185 SILAS DEANE HIGHWAY WETHER FIELD,CT.06109 PHONE: (203)563-3711