HomeMy WebLinkAboutDrain Layers Permit 116 Lisa Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS„
BUREAU OF PA,LL`UTION CONTROL
DRAIN LAYER'S PERMIT ®, 4442
Pursuant to written applicat o , permission is hereby,granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned b "
y ( `� % G' ,^x..ri� whose address is
La House Drain and to
3' Repair House Drain, Lay Main, Other
for ,
Family Units, with acres. occupancy or- use, with
lype of Sewage to he connacted under this permit;
WASTES ( ), OR SANITART SEME , INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
i
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) da s
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. 'A licant has received
Town Permit No, and/or CHD Permit No.
Signed
censed Dr in 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:
Engineering Department Date
Connection Charge Paid `. 17 Permit Fee: Paid $
Check Number C>-
r'
Issued by
Tax Office
INSPECTION r
Date work started Z 1 Date r-mpletoad 2
- ll cient notification received: _� Yes No
Special Conditions
APPROVED:_
Inspector pate