HomeMy WebLinkAboutDrain Layers Permit 97 Lisa Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT X0, 4781
81
VIJ
Pursuant to written application, permission is h
t reb g anted to. the Lic sed Drain Layer
named herein to perfo the work ' dicated--�bel o a J a
at premises owned by , ; n �-
whose address is
House Drain and to
Lay , Repair House Drain, Lay Main
for , Other
Family Units, with acres. occupancy or use, with
TYpe of Sewage to be eenneeted under this p�!rmit: SANITARY
WASTES ( ), OR ( ) SEWAGE , 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 �Z �Dlt�STlZUG7)d�I �,
the holder of Drain Layer's License No. Permit will expire thirty
`=2 -' P Y (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 has r ceived
Town Permit No. and/or CHD Permit No.
Signed
4L::i_censed Drain yer
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 th n me of the Town of South Windsor:
En ineer ng Department Date
Connection Charge Paid 7 Permit Fee: Paid
A,
Check Number . U�;
j') Issued by
J'\ Tax Office
INSPECTION
Date work started �` - '� - �'r" Dare completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date