HomeMy WebLinkAboutDrain Layers Permit 530 Quarry Brook Dri TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
530 QU&rr y &'ppK A r , DRAIN LAYER'S PERMIT 5915
3 h 19
Pursuant to written application, permission is hereby. granted to the
` Licensed Dr in Lave; named herein to perform the work indicated below t
�c�w at premises owned by Z,4C4yi4 CGnC 1
whose address is (Auc_i/IC-Le 7L(J and to
Lay House Drain, x 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 bemade with (�
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date Estimated Time for Completion
Permit to be issued to jdr1CC rQ.
the holder of Drain Layer's License No. 20jr qj j 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 �--��- 1411.2
Licensed sin Layer
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:
Enginee.ring Dept. Date
Permit Fee Paid $,� .�� Check: Number
Connection Charge Receipt No. 4271 Dated r;)-1-7-C�
Issued by
INSPECTION
Date work started - Z Z - Date completed 3- 22.- j
Sufficient notifies=ion rece ve . es No
Special Conditions
APPRO `ZZy
Inspector Date