HomeMy WebLinkAboutDrain Layers Permit 16 Woodhaven Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL ��TT
DRAIN LAYER'S PERMIT X9. 4670
19
Pursuant to written application, permission is hereby granted to.. the Licensed Drain Layer
named herein to perform the work indicated below at '' �.` '
at premises owned by , t ',.' �„� OzCA� whose addres and to
for is
Lay House Drain, Repair House Drain, Lay Main, Other
Family Units, with acres. occupancy or use, with
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 41 , AX / _
the holder of Drain Layer's License No. O Permit will expire thirty 0 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.
i
S�jfned
censed 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:
Engineering Department Date
Connection Charge Paid a'';(1: ;G Permit Fee: Paid
Check Number
Issued by '.
Tax 6ffice
INSPECTION
Date work started Date completed
Sufficient notification received: ,_,- Yes No
Special Conditions
APPROVED: _I
Ins ector'
- Date �
;. . ."to Aorrt ja ava CONSTRUCT/ON 'CO.�
BUILDERS AND DEVELOPERS
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16 Cr 'r c /e
185 SILAS DEANE HIGHWAY WETHERSFIELD,CT.06109 PHONE: (203) 563-3711
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