HomeMy WebLinkAboutDrain Layers Permit 238 Lisa Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 0, 4572
Pursuant to written application, �
PP , permission is her granted to the Lic sed Drain Layer
named herein to perform the work in
jd1cated below atat premises owned b j
y 't C-y' SQ whose address is
v
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
,
Family Units, with acres. us occupancy or e, with
Type of Sewage to be connected
WASTES , OR ( ) , SANITARY , 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. ,. -(97 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 received
Town Permit No, and/or CHD Permit No.
Signed
—L�7 �✓C �c
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�tthheTof South Windsor:
Engineering Depari6ent Date
Connection Paid Charge t',Jw
g '�• '� � Permit Fee: Paid
Check Number
Issued by
Tax Office
INSPECTION
Date work started Date
Sufficient notification rece ve : Yes No
Special Conditions
T APPROVED:
Inspector Date