HomeMy WebLinkAboutDrain Layers Permit 155 Lisa Drive TOWN OF SOUTH WINDS
DEPARTMENT OF PUBLIC WORKS �Y
BUREAU OF-, POLLUTION CONTROL
DRAIN LAYE S PERMIT U.a 4625
19-
15s
Pursuant to written application, permission"is ergby ,gran:ted to • he Licensed Drain Layer
named herein to perfo the Fork Indicated low at s')�T (o(o L S( 1
at premises owned .by - -
=•-- u= L� whole address is
F ` to
Lay House Drain, Repair House Drain, ,_Lay Main and, Other ,
for __ occupancy or use, with
Family Un ts, with acres.
WASTES ( ), OR ( ) INDUSTRIAL
Connection will be made with
Show;. sketch of proposed woii3itwo (2) copies of separate drawings.
y�tule�_�. •
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to m ` C?
the holder of Drain Layer's License No. ��%? _ Permit will xpire thirty (30) days
after da.teSof 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 received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Drain Layer
The above named Drain Layer has a valid lcens issued by the State of Connecticut and
has filed a satisfactoiy bond and insurance poli -i�he name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid 1-1 c) '� Permit Fee: Paid $
-, Check Number �_ C
f.. I Issued by
Tax Office
INSPECTION
Date work started Date cnmpiptad
sufficient notification received: Yes No
Special Conditions
APPROVEDP
Inspector Date
4 ' 2-p `
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