HomeMy WebLinkAboutDrain Layers Permit 20 Lisa Drive (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
s BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT -��N�o, 4897
19
Puftuant to written application, permission is hereb printed to the Licensed Drain Layer
named herein to perform t wor 'ndi at�d a ow at 2
at premises owned by whose address is
and to
Lay Houw- Drain, Repair House Drain, Lay Main, Other
for occupancy or use, with
Family Units, with acres.
underType of Sewage to be CULMUCted is permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish twb (2) copies of separate drawings.
o A,
A .
SPECIAL CONDITIONS
esired Starting Date - Estimated Time for Completion
Permit to be issued to ;?e-
the holder of Drain Layer's License'No. n a�:M?tP . Permit will expire thirty��- 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 rec7iv
Town Permit No. and/or CHD Permit No.
Signed
.'� Lensed Drain Layer
The above named Drain Layer has a valid license is
sue the State of Connecticut and
as filed a satisfactory bond and insurance policin the name of the Town of South Windsor:
Engineering Department Date
-
Connection Char ge Paid (1 r Permit Fee: Paid $
Check Number
Issued by �' l ,a-
Tax Office
NSPECTION /
,�ate work started
Sufficient notification received: Yes No
Special Conditions
APPROVED:
`Inspector Date