HomeMy WebLinkAboutDrain Layers Permit 9 Linda Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 2 5928
19 tr.
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform k indicated below at
a
_ `' ,`N'c -i �; at p r e s e a o w n e d b ,s�1e yr Ir � �'
whose address is and to
Lay House Drain, �,.�" Repair House rain, Lay Main, Other ,
for occupancy or use, wit
Family Units , with acr s.
Type of Sewage to be Conn cte under this permit : SANITARY SEWAGE ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or rnish 'two 2) co ies of separate drawings .
OSHA REQUIREMENT UST BE FOLLOWED
SPECIAL CONDITIQN.S-- - - -
Desired Starting Date VO-1,r ° ,�' ��:: timated Time for C mple ion
Permit to be iss ed to
the holder of Drain L yer ' s License No. :, j ' P mit ill expire thirty
(30) days afterN
issuance. The and rsigned D an ayer hereby agrees
to all the term nditions set forth n the p mit and the reverse side
thereof . Applis received Town Permit No. and/or
CHD Permit No .
Signed.
Li nsed Drain Layer
,,The above named Dra n L er has a al li ense issued by the State of
Connects and has filed a sat ory and nd insurance policy in the
name of the of South indsor:
Eng neering Dept . Date
Permit Fee Paid $ ''` '`'Ch ck mber
Connection Charge Receipt No. _- 5� ( Dated - j -
I78 �led by
INSPECTION
Date work started Date completed
Sufficient notification rece v : --yes No
Special Conditions
APPROVED:
Inspector Date