HomeMy WebLinkAboutDrain Layers Permit 100 Lisa Drive kv-
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NN21. 4782
No U. 0- 1 _ , 19 ) %
Pursuant to written application, permission is h reby gr ted to/ the Lice sed Drain Layer
named herein tolperform the work indicate4 bel w at
at premises owned by
whose address is
La House Drain and to
y Repair House Drain, Lay Main, Other
for ,
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected under this permit;
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
the holder of Drain Layer's License No. 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 rec ed
Town Permit No. and/or CHD Permit No.
Signed
6 Licensed Drain er
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 he ame of the Town of South Windsor:
nginee in Department
P Date
Connection Charge Paid '��- , Permit Fete: Paid $
Check Number tj
0
Issued by
Tax Office '
/H
INSPECTION
Date work started Q 43-99 7 Date completed
Sufficient
on received: Yes No
Special Conditions
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APPROVED:
Inspector Date