HomeMy WebLinkAboutDrain Layers Permit Charing Road Extensi TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT S 18 7
q
Pursuant to written application, permission is hereby granted.-to the
.Lic used Drai ayes n med herein to perform the work indicated b ow a.t
at premises owned by Q���;,
whose aAYdress ,is 1a^ and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type` of Sewage to be connected under this permit : SANITARY SEWAGE �'
INDUSTRIAL WASTES ( ) ,' OR
Connection will be made with %� L
Show sketch of proposed work or urnish 'two (2)- copies of separate drawings.
a s l� an //�l.r
OSHA REQUIREMENTS MUST- BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for CompletionZLZ
Permit to be issued to'
the holder of Drain Layer's yf 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.
l Signed
Licensed rain 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. . Date
Permit Fee Paid $ Check Number
, Connection Charge ,Receipt No. Dated
I s s u e•d by
INSPECTION
Date work started Date completed
Sufficient notification received : Yes No
Special Conditions
APPROVED:
Inspector Date