HomeMy WebLinkAboutDrain Layers Permit 21 Hazel Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5925
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...3 , , 19 1? 2
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
"21 at premises owned by mf]Trr �� ,
whose address is �. f </,Q L and to
Lay House Drain, l Repair House Drain, Lay Main, Other ,
for SiNGtC' l,tY occupancy or use, with
Family Units, with acres,
Type of Sewage to be connected under this permit : SANITARY SEWAGE (-A
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
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6 PUS
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SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date 441:1 9 3 Estimated Time for Completion 41 z 74
Permit to be issued to 7�y'y� dvnE./� � - Sk��'� y� �, � `,l, ,•
the holder of Drain Layer's License No. a2.a�'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
censed Drain Laye
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactoLndnd insurance policy in the
name of the Town of South Windsor: t
E gin ng Dept. Date
Permit Fee Paid $ Z,�.-00 Che k umber -s74-
Connection Charge Receipt No. %• Dikted 3/3
i
Issued by 5r
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INSPECTION
Date work started - Z - Date completed
Sufficient notification rece ve es No
Special Conditionsoo
,
APPROVE S-�}
Inspector Date