HomeMy WebLinkAboutDrain Layers Permit 105 Lisa Drive TOWN OF;. ,SOUTH WI N DSOR.
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION;CONTROL
DRAIN LAYER'S PERMIT 4425
105 Lisa. afi✓2
Pursuant to written application, permission is hereby grant
( 3 d Drain Layer
ed to the Lic se named herein to perfo the wor indi aged elow at a qn
at premises owned by
whose address is
Lay House Drain, Repair House Drain, La Main and to
for y Other
Family Units, with acres. occupancy or use, with
Type of Sewage to be connected
,. OR ( ) ft6E , INDUSTRIAL
Connection will be made with
Show sketch of propos d work or f rnish two (2) copies of separate drawings.
i aa°
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Permit will expire thirty
after date of issuance. The. undersigned Drain Layer hereby agrees to all the terms ands
conditions set forth in the permit and the reverse side thereof. pplicant has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed Dra' 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 the Town of South Windsor:
S6 �, 3 Engineering Department Date
Connection Charge Paid �(� er � Permit Fee: Paid $ (j (�
Check Number ;
Issued by
Tax Office
INSPECTION
Date work started ZO- lam• O Date completed "
a on received: �, Yes No '
Special Conditions
APPROVED:
Inspector Date