HomeMy WebLinkAboutDrain Layers Permit 43 Lisa Drive t TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NNO. 4966
1 0 c) (O , 19L 1
Pursuant to written application, permission is here y rante to he L'cen -ed Drain Layer
named herein to perfo the �idicatel slow a
at premises owned by - ' S V'
who a address is
Lay House Drain, Repair House Drain, La Main and to
for y Other
Family Units, with acres occupancy or use, with
.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ,
ASTES ( ), OR ( ) ( ) INDUSTRIAL
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
® SPECIAL CONDITIONS s
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's Licens(B No Permit will expire thirty
after date of issuance. The undersigned Drain Layer hereby agrees to all the terms ands
conditions set forth in the permit 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 issued by the State of Connecticut and
leas filed a satisfactory bond and insurance policy in the name of the Town of South Wind
sor:
Engineering Department Date
Connection Charge Paid ��^ �8
f Permit Fee: Paid $
1 41L�
CPeck Number H
- � , - } � Issued b ii ��
Tax Office y r , t)
SPECTION
ate work started ; �' �� r t' Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector; Date