HomeMy WebLinkAboutDrain Layers Permit 21 Diggins Court TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERmi N2 5971
J 2- 8 i 9 y3
Pursuant to written application, permission is hereby granted to the
Licen ed Din Layer named �f e n t�q perform the work indicated below at
pr m ses' owned y Cotes
whose address s C U li(J ' o�a,r^
Lay House Dr a n, Repair u e Drain, Lay ,lMain, Other to
for �' J occupancy or use, with
Family Units, with acres...
Type of Sewage to be connected under `this 'permit: SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connectfan. will be made with S ?g p ,
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST FOLLO ED
SPENL271
TIONS
Desired S acting Date " —, }
{ . .
Estimated me for omp1etion , ,
Permit to be issued to �.KJ�n►1Ll��S
the holder of Drain Layer's License No.
71.W-t3?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 in th,e permit and the r side
thereof. Applicant reverse has received Town Permit No. andeve
CHD Permit No
Si ned
Lic sed ain Layer
The above named Drain Layer has a va j license is ued by the State of
Connecticut and has filed a satisfactory bond and IV
rance policy in. the
name of the Town of South Windsor
�f
g nee Dept. Date :
Permit Fee Paid Check ber t r o t )
Connection Charge Receipt No. Q "t Dated
t Q�w
Issued by
INSPECTION
Date work started 8 -q
Date completed
Sufficient notification receive es No
Special Conditions
AP P
Inspector - Da ee -