HomeMy WebLinkAboutDrain Layers Permit 30 Pheasant Way TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 142 5926
Pursuant to written "a lice on permission h PP . P is a eby granted to the
Licensed Drain Layer n amed here to perform the work indicat d below a,t
'la7l �ses owned by ] -T CD/9S
whose addre s is _/ Sc,- a --{
0
Lay House Drain, Repair Ho a Drain, Lay Main, Ot er ,
for , occupancy or use, with
Family Units, wit acres. /--
Type of Sewage to be connected under this permit : SANITARY SEWAGE (Vf,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be, made with
Show sketch 'of proposed work or furnish "two (2) copies of separate drawings.
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date C Estimated Time for Completion T tr
Permit to be issued to
the holder of Drain Layer's License No. fig{3U 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 G
L cens DrXbylthe
ayer
The above named Drain Layer has a valid license issue State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
ngineering Dept. Date
0
Permit Fee Paid $ j •0 Check Number
Connection Charge Receipt No. W1221 Dated y
Issued by /a�z� 9�
INSPECTION
Date work started Date completed
Sufficient notification receive; I—"yes No
Special Conditions �(
AP �Z
nspector Date