HomeMy WebLinkAboutDrain Layers Permit 472 Quarry Brook Dri TOWN OF SOUTH WINDSOR
DEPARTMENT ;OF PUBLIC WORKS '
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ' NO 5708
9 7A G uaxr� sMoa-Dr.
19 /2._-
Pursuant to, written application, permission is hereby granted to the
hicpsed Drain La er amed herein. to perform the work indicated below at
2e. f at premises owned by ja ���;; r
ddress is a t w a and to
Lay s:e Drain, Repair House DrAin, Lay Main, Other
.,
for � ,. occupancy or use, with /
Fami y : `.ats, wi acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES' ( ) , OR ( )
Connection will be made with T?
Show sketch of prdposed work or furnish two (2) copies of separate drawings .
sOOXAL. 00 tT.IO.NS
esir`e St` ft Dite ,Z 2v ?
Estimated Time for Completion 1
Permit be issued to N( l�G le e,r
the h41e1 of .Drain Layer 's L ense o. 7(OB7 .,; Permi will e pire thirty
(30). .days .after date of issuance. The undersigned Orain Layer hereby agrees
to all the terns and conditions set forth in the permit and the reverse side
thereof. Applicant has received Town Permit No. and/or
CHD P rmit No.
Signed
--- L ensed Dr 'n L er
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:
En ne ng Dept. Date '
Permit Fee Paid $_ Check Nu er
Connection Charge Receipt No. A1 ( Dated C 2.
Issued by e� f
w
INSPECTION Q
Date work started Date completed -
Sufficient notification re ^e3'v'eli': es No
Special Conditions
APPROVED
Inspector Date