HomeMy WebLinkAboutDrain Layers Permit 61 Lisa Drive TOWN OF SOUTH Wi N DSOR
!4� DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
1 DRAIN LAYER'S PERMIT Nol 5 066
r�
/ 19
Pursuant to written application, permission is hereby granted to the Licensed Drain gaer
y
named herein to perfo the work indicated below at r ;
at premises owned by i '('
,Whose address is
and to
Lay House Drain, Repair House Drain, La Main
for y Other
occupancy Family Units, with acres. or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( )
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
0 Desired Starting Date Estimated Time for Completion
• Permit to be issued to AY
r. G
the holder of Drain Layer's License No. 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 deceived
Town Permit No. and/or CHD Permit No. f'
Signed
Licensed Drain Layer
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:
Engineer ng Department Date
Connection Charge Paid Permit Fee: Paid
$
is(;
a ,
Check Number
Issued by
Tax fice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector pate