HomeMy WebLinkAboutDrain Layers Permit 194 Lisa Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKe
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT O, 4 3 0
Pursuant to written application, permission is hereby grant -, to the Licensed Drain Layer
named herein to perform the work i d'c�ated b low at
at premises owned b � �0
y `� L 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 Sewaize to
INDUSTRIAL
WASTES ( ), OR ( ) Connection will,
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 i1sued to n' re/Vfi'
the holder of DrainjLayer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Drain ayer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. Applicant has receive
Town Permit No. and/or CHD Permit No.
Signed
Licensed "Drain r
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance pol4n -
gineeri'bgname of the Town of South Windsor:
Department Date
Connection Charge Paid . 11,7Permit Fee: Paid $ C�
Check Number
7sued by
Tax Ot f is e
j
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date