HomeMy WebLinkAboutDrain Layers Permit 5 Lisa Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITjp. 4 5 9
5 Lisa Vf vL
19 '
Pursuant to written application, permission is hereby granted to-�he L'c sed Drain Layer
named herein to perform a work i dicated, below a 1
at premises owned by 7 /rr - ,
whose address is
La House Drain and to
y Repair House Drain, Lay Main, Other
for ,
Family Units, with acres. occupancy or use, with
T e of
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. 222try .3, 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. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
U Licensed Drain Layer
The above named Drain Layer has a valid license issued by theState of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid ( �1 L Z Permit Fee: Paid $
Check Ny�me�t
` GTE Issued by
Tax Office
INSPECTION
Date work started Dat-A completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Da e