HomeMy WebLinkAboutDrain Layers Permit 10 Carson Way TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
f BUREAU OF POLLUTION CONTROL
I
DRAIN LAYER'S PERMIT ' 5997
-Z 19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer amed Aere o rm the work igAAcated below a)t
mp� ses owned by
whose address i t/ c7 . A to
Lay House Drai , Repair F&Vuse Drain, Lay Main, Other ,
for occupancy or use, with
Family units, ,4ith acres.
Type of Sewage to be connected under this permits SANITARY SEWAGE ( '
INDUSTRIAL WASTES ( ) OR )
Connection will be made with _CD A i
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date' __ff Estimated Time for' Completion
Permit .to be issued to =so& � �Q( S
the holder of Drain Layer's License No. le,gjr-30. Permit will expire thirty
(30). days after date of issuance. The undersigned Drain Layer hereby agrees
to all the terms andconditions set . forth in the permit and the reverse side
thereof. Applicant has received Town Permit No. and/or `
CHD Permit No.
Signed r
Lic'en Dra Layer
The above named Drain Layer has a val( !d license issued by the State of
Connecticut and has filed a satisfactory b n and ins ranee policy in the
name of the Town of South Windsor:
UN
n Dept. Date
Permit Fee Paid $ �S,t�U Checber
Connection Charge Receipt No. 4-3 D t e d ! Z 9 3
Issued by
INSPECTION q
Date work started 2� ate completed 9- 2- 9�
Sufficient .notifica on recelvea: es No
Special Conditions
Of
APPROVED
tin spector Date