HomeMy WebLinkAboutDrain Layers Permit 502 Quarry Brook Dri .. ..> }
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 5954
QU &oc)I L, sL" , 19
Pursuant to written appli ation, permission is hereby granted to the
Lid Drain Layer named herein to perform the work indicated below at
L J2,—A at premises owned by _
whose a dyes isti ` , r and to
Lay House Dra n, Repair House ain, Lay Main, Other
for S / occupancy or use, with
Family U its, witA acres. --
Type of Sewage to be connected under this permit: SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR
Connection will be made with
Show sketch of propPsed work or furnish 'two (2) copies of separate drawinghs.
ecf� OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL; O D ITION5
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's Li ense Permit dill a ire thirty
(30) days after date of issua ce. Tfie undersi ned Drain Layer he eby 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 Not
Signed (A le
L:censed Dr n La 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:
E gi a ing Dept. Date
Permit Fee Paid $ ;�!� Chec umber .0 ILL
Connection Charge Receipt No. Dated —�—
1
Issued byAL ?k"J, "Z
INSPECTION
Date work started Date completed -f-r
Sufficient notification received: yes No
Special Conditions
Inspector Date