HomeMy WebLinkAboutDrain Layers Permit 75 Greenwood Drive (2) Y ±� 6
m 339
TOWN OF SOUTH WINDSOR
-� DEPARTMENT of PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
{�G� DRAIN LAYER'S PERMIT cy
DATE:
Pursuant to written app/i ation, p rmission isp4er
y granted to the Ucensed Drain Layer named herein toperform work at ./hi av r� 0 S Lot#_ indica ad ow, at;q4 i
premises owned by 4 r,-► / — whose address is and
to Lay House Drain Repair House Drain Lay Main them , for
occupancy or use, with. acres.
irype of Sewage to be connected under this permit: SAN/TARP SEWAGE( INDUSTRIAL MAS TES(J,
OR()
Connection will be made with
work to be in accordance with Town of South Windsor standards, a//OSHA requirements and the conditions
indicated on the back of this permit.
- s
Proposed start date Estimate time for completion
Permit is to,be issued to ezaC, ., the holder of Drain Layer's License No..
Only holders of P1,P7 & W9 licenses will be issued permit. Permit will ezyke thirty (30)
days g% r date of,issuance. The undersigned Drain Layer hereby agrees to al/the t rms and conditions set
forth'inthe permit and the reverse side thereof. Applicant has:ceZ1vTown S cavadon Perm it No.-
and/or ConnDOT Permit No.
Signed
Licensed Drain Layer
FOR TOWN USE ONLY
Permit Fee Paid$ Z5,00 (Check No.) Q 0 A 7 2-- —
Y N Connection Charge $ 6 oa,n n (Receipt No.J d s 7 4 Dated 9-L o-
Insurance on File
Bond on File X O This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on file, satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( 1
Record of Sewer
Assessment ( J ( J Issued by Date '
1N&PEETION..
Date Work Started Date Completed
Comments
APPROVED:
Inspector - - -Date - -