HomeMy WebLinkAboutDrain Layers Permit 132 Lisa Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4278
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Pursuant to written application, permission is hereby nt to t4 Licensed Drain Layer<
named herein to perforri the work indicateq below at
at premises owned by f ' 5)
whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with acres occupancy or use, with
.
Type of Sewage to be
WASTES ( ), OR ( ) S*NITA , 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 �Li'(1 ��S7
the holder of Drain Layer's License No.
? gZ.. Permit will. expire thirty (30) days
after date of issuance. The undersigned Drain ayer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof. Applicant has rece' ed
Town Permit No. and/or CHD Permit No.
Signed
censed Drain L
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy 'n the name of t e Tow of South Windsor:
Engineering epar t
Date
Connection Charge Paid'jOd o, �-!U'�1�G-, Permit Fee: Paid $
Check Number
/ 1 Issued by
Tax dff�.ce
INSPECTION
Date work started Date Completed
-Suffidlent notification received: Yes No
Special Conditions
- APPROVED:
Inspector pate