HomeMy WebLinkAboutDrain Layers Permit 103 Kelly Road .. ::r TOWN OF SOUTH W!N DSOR
DEPARTMENT OF,PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT " O 5794
�1 t> 19 7 z
Pursuant to written application, permission is hereby granted to the
Licensed D ai La named herein to perform the work indi at d Wow at
at premises owned by U
whose addrese a d to
j Lay Hous Dr in Repair House Drain, Lay Main, Other ,
for a occupancy or use, with
f Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (�) ,
.INDUSTRIAL WASTES OR )
Connection will be made with n
Show sketch of proposed work or furnish twq_�2) copi s of separate drawings.
ITW
r 0/ (%mil
I
.
z 15 ' .� ill
-OPECfAL CONDhTIO'NS
Desired Starting Date Estimated Time for Com-pletion } ,
Permit to be issued torZ� �
the 1holder of Drain Layer's License No Permit will expire th: rty
(30) days after date of issuance. The,.under.signed Drain Layer hereby'-agrees
to all the terms and condition's set forth- in the permit and the rege,r e. side
thereof. Applicant has received Town Permit No . and/or :
CHD Permit No.
a� ��S Signed
9 / 0 Licensed Drain Layer
The above named Drain Layer has a vali license . issued .by the State' of
Connecticut and has fil'ed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
g veering Dept, Date:
Permit Fee Paid $ .�� Check tuber
Connection Charge Receipt No* 1 Dated. , -��-�
Issued by
INSPECTION
Date work started 2 - 2 Date completed
Sufficient notif ica on ce ve '""des No
�f
Speci Conditions qe
APPROVE
- o Date
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PROJECT: r DEVELOPER:
STREET: CONTRACTOR:
DATE: " 2. ^ 9 TIME: `3e . /k , —.�. �v
z Z, 30
/o/k
WEATHER: �C1.(,M, (�' � INSP:
WORTS IN PROGRESS:
r
alrip
d
7
r
r r
�l 1"a col
SPECIAL INSTRUCTIONS:
7