HomeMy WebLinkAboutDrain Layers Permit 108 Lisa Drive TOWN (/SOUTH, WINDSOR
4EPAR-t4ENT OF PUBLIC WORKS
BUREAU OF POLLUTJQN CONTROL
',,- ..DRAIN LAYER'S PERMIT Jb. 4612
19
ion, permission is hereby granted to the �icensed, Drain L yer
Pursuant to writt Vna��1'i!, at__PaV_
a .
named herein to perform the work indicated below at
at premises owned by
whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other
for — occupancy or use, with
Family Units, with acres.
Type of Sawage to be oonneeted under this peru,±t; SANITARY SEWAGE INDUSTRIAL
WASTES ( ), OR ( ) '
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. 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 re eived
Town Permit No. and/or CHD Permit No.
Signed
censed DraidLa r
The above named Drain Layer has a valid license issuedAy the State of Connecticut and
has filed a satisfactory bond and insurance policy/11i .the riamd,, of the Town of South Windsor:
ng i nn e ring Depar went Date
Connection Charge Paid Permit Fee: Paid $
Check Number
V) Issued by
Tax Office
INSPECTION
Date work started pleted
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date