HomeMy WebLinkAboutDrain Layers Permit 36 Elderberry Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL-
DRAIN LAYER'S PERMIT 5 918
2) `� , 19 c1
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
L , ,A VV t at premises owned by V,CU
whose address is _20 7 77 L S and to
Lay House Drain, �R Repair House Drain, Lay Main, Other ,
for & !, le ,&Ii",Mo 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 Estimated Time for Completion
.Permit to be issued to
the holder of Drain Layer's License No. -2g;&aqk . 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.
Signed-
icensed Drain yer
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 �-tSR
Connection Charge Receipt No. Dated ( aJ-C
Issued by
INSPECTION
Date work started Date completed *3 -pzi
Sufficient notification' e ei e : es No
Special Conditions
AP
Inspector Date