HomeMy WebLinkAboutDrain Layers Permit 90 Lisa Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNO, 4722
qd
19
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Pursuant to written application, permission is ereby granted to the Licensed Drain Layer
named herein to perf rm the work indi ted be w at ��6-1 3
at premises owned by (� whose address is
House Drain and to
Lay , Repair- House Drain, Lay Main, Other
for
occupancy or use, with
Family Units, with acres.
Type of Sewage
-annected under this permit. SANITARY SEWACE WASTES ( ), OR ( ) � 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.
� 7 permit will expi e 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 received
Town Permit No. and/or CHD Permit No.
Signed
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 poli n t name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid -o 0 11:7:F V Permit Fee: Paid $
r
Check Number
Issued by
Tax Office
INSPECTION
Date work started
u, icient notification received: Yes No
Special Conditions
APPROVED.
Inspector Date