HomeMy WebLinkAboutDrain Layers Permit 098 Austin Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 0 5966
19AL
Pursuant to written application, permission is hereby granted to the
Licensed Dr�n aye � nam'� erein at
perform the work indicated below t
' p emises owned by T Oh S
whose address is
Lay House Dr in, Repair Mouse Drain, Lay Main, Oth to
for � � occupancy or use, with er
Family Un s, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ( ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with eD
Show sketch of proposed work or furnish 'two (2) co/ptes of separate drawings.
OSHA EQUIREMENTS MUST BE OLL WED
S ECIAL CONDIT ONS
Des red Starting Date /� Estimated Time for Completion
Permit to be issued to ,�ok) 0a(,z!S
the holder of Drain Layer ' s License No. -Z! gl? 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.
Signed
is se 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:
Engineering Dept. Cl/ Date
Permit Fee Paid $ ��� Check Number �U j Z5
Connection Charge Receipt No. _ 4 Dated 57_1 l
Issued by
INSPECTION
Date work started Date completed
Sufficient notification rece eg Yes No
Special Conditions
APPROVED-- - 7
Inspector Dat l