HomeMy WebLinkAboutDrain Layers Permit 218 Lisa Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1X0, 4368
19
Pursuant to written app�2 ca1tion, permission is here nted the ensed Drain Layer
named herein to perfo the workndica d be ow at 7 >
at premises owned by
whose address is
Lay House Drain, Repair House Drain, La Main and to
for y , Other
,
Family Units, with acres occupancy or use, with
.
Type of Sewage to b
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
r_.
Permit to be issued to a — IZr�
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 e/c ived
Town Permit No. and/or CHD Permit No.
Signed
Licensed ra' ayer
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance po\licy,,ir ther4ame of the Town of South Win sor:
ginee � a merit �
3
Date
—4
Connection barge Paid Sl� 9 t �'� Permit Fee: Paid
- c
Check er ,-US-16
Issued by
Tax 0 fice
INSPECTION
Date work started Date completed
SUfficient notification received: Yes No
Special Conditions
APPROVED: ,
Inspector Date