HomeMy WebLinkAboutDrain Layers Permit 17 Lisa Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
• BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT o, 4 8 9 6
Pursuant to written application, permission is her y ra d to the L' 'ensed rain Layer
named herein to perform he work ' disc te�el at ���
at premises owned by K� M/CC whose address is
and to
Lay HouV- Drain, Repair House Drain, Lay Main, Other
for occupancy or use, with
Family Units, with acres.
,t
Type of Sewage to be eenneeted under this
• , INDUSTRIAL
orASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
31
Gh
C
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to -��--�
the holder of Drain Layer's License No. 7-0 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 h received
Town Permit No. and/or CHD Permit No. 2 D$2
Signed
icensed' Dra' Layer
The above named Drain Layer has a valid license issued by the State of Connecticut and
Was filed a satisfactory bond and insurance policyjin the name of the,Town of South Windsor:
Engineering Department Date
Connection Charge Paid f 7 Permit Fee: Paid $ S /
Check Number
Issued by
Tax Of ice
INSPECTION —2-T 7
ate work started Date- completed L&I 7
Sufficient notification received: Yes No
Special Conditions -
PPff6V — ?
Inspector ^Date