HomeMy WebLinkAboutDrain Layers Permit Ridge Road (2) ^rr* "+-a Si: rt.oil
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TOWN OF SOUTH WINDSORVey
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DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTIOND �
CONTROL _
DRAIN LAYER'S PERMIT .6 07
19�
Pursuant to written application, permission is hereby granted to the
Licensed D ain ayer na d ,herein to perform the work indicated elow at
)i' S E' at premises owned by v, 1 ,f�
whose ddress 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 ( t
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with -5'1y 3S sew(2- a44f .
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREME TS UST E LLOW�D
SPECIAL CONDITIONS
Desired Starting Date //L-3 —35/ Estimated= Time for Completion Fj/,,�,&& S
Permit to be issued to 3-e7Ati
the holder of Drain Layer's License No. 2tVfflojo . 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
-
Signed
VLicenajed Dr Lager
The 'above named Drain Layer has a valid. license issue by the State of
Connecticut and has filed a satisfactory bond and insurance pol4cy in the
name of the Town of South Windsor :.
j?�a✓1L G--j��� Engir4eriiig Dept. Date
Permit Fee Paid $ Check Number
Connection Charge Receipt No. Dated
Issued by �,
INSPECTION
Date work started Date completed
Sufficient notification recelveal yes No
Special Conditions
APPROVED:
Inspector Date