HomeMy WebLinkAboutDrain Layers Permit 156 Lisa Drive TOWN OF., �6,UTH WAN DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT U 4 3 0 3
e.
19
Pursuant to written application
, permission is Uc ���Q. 2` ,
named herein to perform e work at
�icateA below her b to tJtke Licensed Drain Layer
tfS`
at premises owned by a
whose address is
Lay House Drain, Repair House Drain, and to
for Lay Main, Other
Family Units, with occupancy or use, with
acres.
Type of Sewage to be connected under this WASTES OR ( ) ITARY SEWAGE ( , INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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if
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1
SPECIAL CONDITION S
Desired Starting Date
lEstimated Time for Completion
Permit to be issued to ~
the holder of Drain Layer's License No.
g �"' "'4 Y * Permit will expire thirty (30) days
after date of issuance.
The undersi ned Drain Layer hereby agrees to all the terms and
conditions set forth in the permit and the reverse side thereof.
Town Permit No. and/or CHD Permit No. Applicant has received
Signed
4
Licensed Drain r
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 a name of the Town of .South Windsor: �
Engineering epartment ^ Z D
i� Date
\\Connection Charge Paid
Permit Fee: Paid
_. Check N, u° �e-- !!!
Issued by
`. Tax Office
startedDate
tift
cation received:` Eemp�eted
Yes No
�ditions
APPROVED
Inspector pate