HomeMy WebLinkAboutDrain Layers Permit 030 Austin Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT I-0 5998
f 19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer na ed herein to perform the work indicated below at
2 ,S + 1,-c _ at preen ses owned by �'!Y1 .�Dort C K
whose address is S g E /► p, (,{/, ' c/ G./"
Lay House Drain, Repair Ouse Drain, Lay Main, Other to
for F-,d/P/k occupancy or use, with < /, ;j -�
Family Units, with VW acres.
Type of Sewage I/t'obeecconnected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with _ SDR 3 S SeGT1D
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED -P' 1r4� St`'C S
SPECIAL CONDITIONS
Desired Starting Date - 3 Estimated Time for Completion / ,y-T
Permit to be issued to
the holder of Drain Layer's License No. 20,S&30 . 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 received Town Permit No. and/or
CHD Permit No. .
i
Signed
License rai � yer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory bond and ins rance policy in the
name of the Town of South Windsor:
g Dept. Date
Permit Fee Paid $ S �U Chec 7=Dre6�r— =4-- C r'ICu
Connection Charge Receipt No. J- ( Dated
Issued by
1 >.
INSPECTION
Date work started -//- Date completed 9-//-�-T
Sufficient notification reca ve : &7 'yes No
Special Conditions
APPROVED:
Inspector Date