HomeMy WebLinkAboutDrain Layers Permit 186 Lisa Drive (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT moo. 4 5 5 7
19
Pursuant to written application, permission is ereby,gra ted to tie Licensed Drain Layer
named herein to perforR the. work I ndmated below at /
at premises owned by (,{, t % r- ; G( �;
�t;4 -1-f+ r • _ whose address is
-� and to
Lay House Drain, Repair House Drain, Lay Main, Other
for
occupancy or use, with
Family Units, with acres.
Type of Sewage tQ be connected under this
WASTES ( ), OR ( ) permit: INDUSTRIAL
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 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 the name of the Town of South Windsor:
n-ineering Department Date
Connection Charge Paid Permit Fee: Paid $ J(�
Check Number (4 3
Issued by
iI Tax Office
INSPECTION
Date work started Dat-,- completed
SilTicient notification received: Yes No
Special Conditions
- APPROVED:
Inspector pate