HomeMy WebLinkAboutDrain Layers Permit 226 Lisa Drive TOWN OF SOUTH . WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION`CONTROL
DRAIN LAYER'S PERMIT o, 4301
Pursuant to written application, permission is her �grantedoe La er
named herein to perfor�► ,the work �dic ted be ow at `4_ L y
at premises owned*by t
whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with acres. occupancy or use, with
Type of Sewa
WASTES ( ), OR ( ) AGE , NDUSTRIAL
Connection will be made with
4 Show sketch of proposed work or furnish tw (2) copies of separate drawings.
SPECIAL CONDITIONS
GAS.
Desired Starting Date Estimated Time for Completion
Permit to be issued to ��/✓ ^��?`
the holder of Drain Layer's License No.'?p
Permit will expire thirty (30) days
after date of issuance. The undersigned Drain ayer hereby agrees to all the tefts and
conditions set forth in the permit and the reverse side thereof. Applicant has rece'
Town Permit No. and/or CHD Permit No.
Signed
icensed Drain La
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:
Engine ring Department Date
Connection Charge Paid (-r5e, 3 Permit Fee: Paid $ _.Ib,!;,6 -
Check Number �;7
Is sued by
Tax Office
INSPECTION
Date work started
icidnit notification received: Yes No
Special Conditions
APPROVE
Inspector Pate