HomeMy WebLinkAboutDrain Layers Permit 148 Lisa Drive TOWN OF SOUTH Wt N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLL TION CONTROL
,
DRAIN LAYER'S PERMIT a 4443
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to. perform,'the work indi�ra�ted below at
at premises owned by rl; f _ 'T , ,!( -e
"� ' ' whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with acres occupancy or use, with
.
underis permit: SANITARY SEWAGE_( -) ' INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
l 4A
r
SPECIAL CONDITIONS
Desired Starting Date Estimated
me. for Completion
Permit to be issued to t
the holder of Drain Layer's License No. Permit twill 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.
Town Permit No. pplicant has received
and/or CHD Permit No.
Signed.
icensed 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 in the name of the Town of South Windsor:
Engineers g D p rtment Date
connection Charge Paid 4-5 f, 33 Permit Fee: Paid $
- n Check Number !� (
Issued by
Tax Office
INSPECTION
Date work started
DatL- completed
Sufficient notification received: r_ Yes No
Special Conditions
APPROVED:" -s
Inspector Date