HomeMy WebLinkAboutDrain Layers Permit 29 Parkview Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT tit IWD 6060
/ 2 7 . 3 19
Pursuant to written application, permission is hereby granted to the
Licensed �Drain Laver named herein to perform the work indicated below at
v� f/ C,ci "-? at premises owned by
whose address is and to
Lay House Drain, y Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with / i/ :?
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
Permit to be issued to
the holder of Drain Layer's License No. ]. - 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 .c,A �L
' Licensed Drain L r
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
Engineering Dept. Date
Permit Fee Paid Check Number C/<,o G ,
Connection Charge Receipt No. ���/]�� Dated
Issued by
INSPECTION
w c
Date work started /� - j Date completed ?I C1 —�T3
Sufficient notification ece ve : es No
Special :Conditions
APPROVED:
Inspector Date