HomeMy WebLinkAboutDrain Layers Permit 533 Quarry Brook Dri ' TOWN OF SOUTH WINDSOR
' 19� DEPARTMENT OF PUBLIC WORKS
I BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT v 5 914
J 33 Qua rr� 6-b o#< Q r • ?IA5 19 9..3
Pursuant to written application, permission is hereby granted to the
Lic used D ain Laye named herein to perform the work indicated below at
J. at premises owned by ns
whose address is and to
Lay House Drain, 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 (X) ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
SPECIAL CONDITIONS OSHA REOUIREMENTS MUST BE FOLLOWED
Desired Starting Date Estimated Time for Completion
Permit to be issued to 40An ey Corp
the holder of Drain Layer's Li ense No. .206 9/7 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
Licensed ain 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:
IX-55 2)
Engi eering Dept. Date
Permit Fee Paid $ Q'j.4U Check Number Connection Charge Charge Receipt No. OV,-396 Dated
Issued by
r ,ems
INSPECTION
Date work started Date completed Sufficient motif ica on ece ve es No --------
Special Conditions
APPROU %
Inspector Date