HomeMy WebLinkAboutDrain Layers Permit 730 Governors Highwa TOWN Of SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N! 6002
d 19
Pursuant to written application, permission is hereby granted to the
Licensed D ain Layer named herein to perform the work indicated below at
'7 �U Uy�"7yt Layer
y at remises owned b
P Y
whose address is '7?o r^n',n„pne,c Ni94t..)9V and to
Lay House Drain, ,,-," Repair House Drain, Lay Main, Other ,
for s occupancy or use, with
Family Units, with acmes.
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 f sh 'two (2) copies of separate drawings.
171 e r
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired . Starting Date Estimated Time for Completion
Permit to be issued to _ nc�. ,rw'� � �s tis7�vc �u, 7 1l111.-4*G /'- r1-1xAF7'1
the holder of Drain Layer's 14censfi No. jopr>•7 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
-� L cens Drain 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:
/1D
n 3
ngine g Dept. Date
Permit Fee Paid $ Ch ,ck Number Q
Connection Charge Receipt No. l ated
Issued by !
1
INS-P ECT I-ON _
Date work started 6/ _3 Date completed
Sufficient notification receive : es No
Special Conditions
APPROVED: .
Insp ctor Date
fi
F
SPECTION, REQUEST k
Date t Time:
Requeazew
St
Location: 7D6Wo
Day: me 30
Time: / " _
Type of Inspection:
( V) Sanitary/Lateral
permit number
( ) Subdivision
( ) Site e
( ) other