HomeMy WebLinkAboutDrain Layers Permit 527 Quarry Brook Dri TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
5 a rI Q ( ro �f • DRAIN LAYER'S PERMIT N2 5927
i 12A 19 fY
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below a
Lit" z oud It at premises owned by
whose address is and to
Lay House Drain, Repair House Frain, Lay M in, Other ,
for .f" .-r� °.,.��h occupancy or use, with r
Family Uhitd, w h acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE
INDUSTRIAL WASTES ( ) q OR (
Connection will. be made with p1/e- ,o,
Show sketch of propose w rk 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 Awt c
the holder of Drain Layer's L ens No. P r it wi .1 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 reverseside
thereof. Applicant has received Town Permit No. and/or
CHD Permit No. .
Signed ("�) , 401 (I�2"I�
L ensed Drai Lay
fY
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:
i
Engineering Dept. Date
Permit Fee Paid $ ?,/,i Check Number
Connection Charge Receipt No. Dated 7 1,9`5V
Issued by
INSPECTION
Date work started Date completed 4 9-3
Sufficient notification rece ve ,7`—'Yes No
Special Conditions
APPR
Inspector Date