HomeMy WebLinkAboutDrain Layers Permit 28 Lisa Drive OF SOUTH i ..:
WINDS��R• .w
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S'PERMIT d, 5034
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at r V
-
at remises owned b
whose address is
Lay House Drain, Repair House Drain, Lay Main, and to
for Other
occupancy or use, with
Family Units, with acres.
•
Type_ of Sewage to be tonne
WASTES ( , OR ( ) under tbi-s . SANIT-ARy IAL
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 f Completi
Permit to be issued to
the holder of Drain Layer's Lice Now" Permit will'-
ill xpire 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 Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy in e n e of the Town of South Windsor:
Engineering Department - �.., Date
Connection Charge Paid Permit Fee: Paid $
Check Number
a' ➢i- 1(..:: Y� Issued by
Tax Office
NSPECTION
Date work started Date c
ompletad
Sufficient notification received: es No
Special Conditions
y
APPROVED:
Inspector Date