HomeMy WebLinkAboutDrain Layers Permit 255 Lisa Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT c, 4847
�1 r
' 19-Q
o�55 �icoa IJr.
Pursuant to written application, permission is 4ereby ra t d to t e . icensed Drain Layer
named herein to perform the or ,indicad be o at �` `
at premises owned by f
whose a ress is
and to
Lay House Drain, Repair House Drain, Lay Main, Other
for
o
Family Units, with acres. ccupancy or use, with
Type of Sewage to be Genneeted under this permit; SMITARY C
WASTES ( ), OR ( ) , USTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS L_f-S Z>9we
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Z08111. 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 has rec 'ved
Town Permit No. and/or CHD Permit No.
Signed
TZ/cinsed Drain La
The above named Drain Layer has a valid license issued by the State of Connecticut and
has filed a satisfactory bond and insurance policy the na of the Town of South Windsor:
Engineering epa ) nt Date
Connection Charge Paid Permit Fee: Paid $
�1 Check Number i; ( C
Issued by
Tax Office
INSPECTION
Date work started_ -e?_ _
Date completed 77-Z"- 7--
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Insp ctor Date