HomeMy WebLinkAboutDrain Layers Permit 543 Clark Street r
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6006
1953
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
— )-71 * 3 N dAit-S at premises owned by
whose address is /7y� / C' A) 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
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date -17- Estimated Time for Completion
Permit to be issued to $��� G, - L 6761r✓.fT
Cam✓ /
the holder of Drain Layer's License No. Za7 *9. Permit will expire thirty
(30) days after date of issuance. The undersigned Drain Layer hereby agrees
to all the terms and conditions set _ forth inft' a permit and the reverse side
thereof. Applicant has received Town Permit-` N and,/or��
CHD Permit No. � �
Signed. L
censed Dr i ,Layer
The above named Drain Layer has a v6on
icense issued by the State of
Connecticut and has filed a satisfactoryand insurance policy in the
name of the Town of South Windsor
Ong neer Dept. D e
Permit Fee Paid $ ax)--,dy Checkember
Connection Charge Receipt No. "' _
8 P Rated �
Issued by/ 3
1
INSPECTION
310
Date work started 99 Date completed Ad,.Sufficient notificatlon receivea; yes No
Special Conditions
APPROVED•
Inspector Date
a