HomeMy WebLinkAboutDrain Layers Permit Lawrence Estates Mai V - ---------R--err^
6315
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
_DRAIN LAYER'S PERMIT
DATE: C/
Pursuant to written application, perm/s /one is hereby gra red to the Licensed Drain Layer named herein to
perform work at409 Ltd/' h i" Lot# as indica ed be/ w, t
premises owned by' Xp kn ,yg„���hose a dress is and
to Lay House Dr
occupanc y,or use, with acres.
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Type of Sewage to be connected under this permit* SANITARY SEWAGE. INDUSTRIAL WASTES 11,
OR (J Connection will be made with S R
work to be in accordance with Town of South Windsor standards, a//OSHA requirements:and the ditions
ind/cated on.the back of this permit.
Proposed start date `" `- Estimated time for completion
Permit is to be issued to J icc C 1z()Las the holder of Drain Layer's License No.
ZC' 19 Q . Only holders of P1, P7 & W9 licenses will be issued permit. Permit will Mire ifiirty (30J
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 Street Excavation Permit No.
and/or ConnDOT Permit No.
Signed J61/ki'l—
FOR TOWN USE 0K Y
. Permit Fee Paid$ 2.5'.00 (Check No.) p6�� Z
Y N Connection Charge s K14ZL (Receipt No.J "women" Dated
Insurance on File (Vf( J
Bond on File (Vf( This permit is hereby issued to the above named Drain Layer who has a valid
/n ense issued by the Stags of Connecticut and has on file,se sfactary bond
Prem/ses subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement (t/j( J
Record of Sewer
Assessment ( J (W Issued by Date /
INSPECTION
Date Work Started Date Completed
Comments
APPROVED:
F Inspector Date