HomeMy WebLinkAboutDrain Layers Permit 210 Lisa Drive TOWN OF .`BOUT'" WINDSOR
DEPARTMENT ;pF PUBLIC WORKS
BUREAU OF i�bLLUTION CONTROL
DRAIN LAYER'S PERMIT 0 4304
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2)D 2-
Lisa Wde, Z- , 19 Xb
Pursuant to written application, permission is hereby ra ed to t L* ens Drain Layer
named herein to perfo he wo k icate ibelo cat
at premises owned by . 44
-
whos address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with acres occupancy or use, with
.
Type of Sewage to be connected
WASTES OR ( ) SANIMARY IAL
Connection will be made with
Show sketch of proposed work or furnish wo (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued toj,�y�.
the holder of Drain Layer's License No. 20 Z Permit will expire thirty after date of issuance. The undersigned Drain ayer hereby agrees to all the terms ands
conditions set forth in the permit and the reverse side thereof. Applicant has receiv d
Town Permit No, and/or CHD Permit No.
Signed
Li nsed Drain L r
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy a name of the Town of South Windsor
Engineering Department Date
Connection Chafe Paid (� Permit Fee: Paid $/
l
!% Check Nu e
Issued by
Tax Office
INSPECTION
Date work started `}`--- Z C Date completed
Sufficient notification rece ve, : es No
Special Conditions
- APPROV
n
_ 7 5
Inspector pate