HomeMy WebLinkAboutDrain Layers Permit 50 Lisa Drive a z TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
~ DRAIN LAYER'S P_ERMIT NNO, 5 011
6L &,tAA ` ' �� 19---I
Pursuant to written application, permission is ereby grant d to. th Licensed Drain Layer
named herein to perfo - the work
, I di
cat be o at ' �_ j��� V )f
at premises owned by / whose address is
and to
bLay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use, with
Family Units, with acres.
O
Type
WASTES ( ), OR ( ) Connection will be made with
of Sewage to hp rnnnac!tad Under this' -permit: SANITARY SEWM�E INDUSTRIAL
Show sketch of proposed work or furnish two (2) copies of separate drawings.
w
t
SPECIAL CONDITIONS
Desired Starting Date Est i ed ime r let on
Permit to be issued to
the holder of Drain Layer's ense Permit will ex /e thirt (30) days
after date of issuance. The undersigned Drain Layer hereby agrees to all the erms and
conditions set forth in the permit and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
9
AL
or Signed
Licensed Drain Layer
The above named Drain Layer has a valid license i d by the State of Connecticut and
as filed a satisfactory bond and insurance policy i name of the Toyn of South Windsor:
Engineering Department Date
Connection Charge Paid �/ 7J �_=� Permit Fee: Paid $ v
Check Number ` 0
i - Ac 1 V� !� Issued by/<r / ) Fcl -
jTax Office
NSPECTION
ate work started
Sufficient notification received: Yes No
Special Conditions ✓�
APPROVED:. ���`_ 4�, i Z _
Inspector Date