HomeMy WebLinkAboutDrain Layers Permit 9 Kellogg Circle y' TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
ho DRAIN LAYER'S PERMIT , 59731.
i993
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer name t} rei to perform the work indicated below at
premises owned by �� �
whose address is 5' ,Gl� Jso,,� to.
Lay House A ain, Repafir House Drain, Lay' Main Oth r
for occupancy o use, with
r ,e
Family Unit , with 3 acres.
Type of Sewage to 'be connected under this permit : SANITARY SEWAGE ( ) ,
INDUSTRIAL_WASTES ( ) , OR
Connection will be made with 3S" �o Wit Ipao ;
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion #G•
Permit to be issued to �, arMt)jS
the holder of. Drain Layer's License No 'Zogg1 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
Si.gne�l C. .)
�. ice sed DCain Layer
The above named Drain Layer has a valid license is ued by the State of
Connecticut and has filed a satisfactory bon and insurance policy in the
name of the Town of South Windsor: i
ng neer g Dept. Date
Permit :Fee Paid $ S.dO Check N mber \\A .,\
Connection Charge Receipt No. A Vated
Issued by
INSPECTION
Date work started -- 2, Date completed �" Z
Sufficient notification rece ve : ----,---Yes No
Special Conditions
APPROVED: _a
`- Inspector Date