HomeMy WebLinkAboutDrain Layers Permit 240 Lisa Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITJo• 4371
2g0a�r��� _ , 19
Pursuant to written application, permission is hereby granted to the 'censed Drain Layer
named herein to perform- a wo k 'ndicat below at A-V ?'7-5- )ice
at premises owned bye 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 Sewage to he connected under "
C
WASTES ( )s OR ( ) � TRIAL
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 toCLLl�►'�
the holder of Drain Layer's License No. D >. 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, pplicant has receive
Town Permit No. and/or CHD Permit No.
Signed
icensed Drain Lay
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance polic - n';the of the Town of South Windsor:
E inee ing epart nt ate
� r
Connection Charge Paid (� ~ 1� Permit Fee: Paid- $ /r��-"" S
Check Number
E 1" Issued by
Tax Office
INSPECTION
Date work started Data completed
sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date