HomeMy WebLinkAboutDrain Layers Permit 100 Diane Drie TOWN OF' SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYERS PERMIT - M 5983
AA 19
Pursuant to written application, permission id here y granted to the
Licensed Drai-irrt Layer named herein to perform the work indicated below ,at
laa &eIgl /£ at' premix owned by; _
whos* address is and to
Lay House Drain, Repa�r House Drain, Lay Main,' Other
for - occupancy or use, with
Family Units, with jw'it -
. Show ycres.
Type of Sewage tnnected under this permit: SANITARY' SEWAGE
INDUSTRIAL WASTES ( )
Connection will be ma sketch of proposed work or furnish 'two (2) copies of separate -drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Start ing ,Date Estimated Time for Completion
Permit to be issued to L./ (./��Ic'f T d3i1
the holder of Drain Layers License No. „OS 7_5sF Permit will expire thirty
(30) days after date of issuance. The undersigned Drain Layer hereby agrees
o all the terms and conditions set . forth in the permit and the. reverse aide
thereof . Applicant has received Town Permit No. andtor '
CHD Permit No. q_3101105`73.
Signed -f
Licensed rain er
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 $ heck Number
Connection Charge Receipt NO. l 149 Dated /
Issued by
INSPECTION
.Date work started '�- ��p- 9 Date completed �] ��0 917
Suf f icient notification recelveQ. es No `----
Special Conditions
APPROV -J
hip c or Date