HomeMy WebLinkAboutDrain Layers Permit 111 Lisa Drive (2) TOWN OF SOUTI WI N DSOR
w
DEPARTMENT OF PUBLIC' WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT, 4844
-F
19 G� ,
Pursuant to written application, permission is hereby, rant d to the Licensed Drain Layer
named herein to perfo the work indicated below at
at premises owned by whose address is
and to
Lay House Drain, Repair House Drain, Lay Main,
for Other
Family Units, with acres. occupancy or use, withType of Sewage to be connected Mider this
1 : SANITARYGE , INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copie of separate drawings.
s�2c-EFT
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to $YL% iyr �/ rLe•�z�`y
the holder of Drain Layer's License No. 2 o t,Z 93 . 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. A licant has receiv d
Town Permit No. and/or CHD Permit No.
Signed
"used Drain Laye
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:
E ineering Depar went Date
Connection Charge Paid '}F Permit Fee: Paid $
Check Number
Issued. by
Tax Office
INSPECTION
Date.wor a Bate eemplete
Sufficient notification received: i/ Yes No
Special Conditions
APPROVED: _
Inspector Date'.--