HomeMy WebLinkAboutDrain Layers Permit 410 Benedict Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5984
l!,Z 19
Pursuant to written application, permission is hereby granted to the
Licensed Drain TayeF named herein to perform the work indic4Ved, below a
�4 T L at premises owned by
whose address is ZK*— = and to
Lay. 'House Dram, -36 _Repair House Drain, Lay Main, Other ,
for ,4,,,�ov. �r.. occupancy or use, with /
E Family Units, with * acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE
INDUSTRIAL WASTES _ ( ) , OR ( )
Connection will be made with
Show sketch of proposed wor or fug ish 'two 2) cop'i separate drawii�ttgs.
Y
6113
OSHA REQUIREMENTSMUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimat d Time for Completion
Permit ,to be issued to
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 received Town Permit No, and/or'
CHD Permit No. .
Signed
Licensed 'Drain Layer
The above named Drain Layer has a val 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:
E g n ng Dept. tel
Permit Fee Paid $ � -f>Q Chec' umber 197y
Connection Charge ,Receipt No. LDated ,
Issued by ?/ )
_r
INSPECTION
a \`
Date work started (0 - 3 Date completed
Sufficient notifica on rece vet: --yes No
_Special Conditions
APPROVE ,
Inspector 4a-Zte—
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