HomeMy WebLinkAboutDrain Layers Permit 67 Lisa Drive i TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT a. 5072
VI USG, br` f .". 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by
whose address is
La House Drain and to
y , Repair House Drain, Lay Main, Other
for ,
Family Units, with acres. occupancy or use, with
permit: SANITARY SEWA E INDUSTRIAL
WASTES ( ), OR ( ) 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
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undyersigned Drain Layer hereby agrees to all the terms and
conditions set forth in the per and the reverse side thereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
Licensed' Drain Layer
The above named Drain Layer has a valid license i sued by the State of Connecticut and
has filed a satisfactory bond and insurance policy the/name of the �gwn of South Windsor:
i �/
Engineerin Department —�`- Date
Connection Charge Paid Permit Fee: Paid $ j
Check Number
Issued- by
Tax Office
INSPECTION
Date work started
Sufficient notification r eived: ` _,, Yes No �.
Special Conditions
APPROVED:
Inspector pate