HomeMy WebLinkAboutDrain Layers Permit 48 Ridgefield Drive 5456
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
'BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT qq
DATE: 2— -�P J '.
Pursuant to written app!/cat/ ermi sro�/i hereby granted to the Licen ed Drain Layer named herein to
perform work at 2 �,t0 , Lot# as indicated below, at
premises owned by d «, whose address is and
to Lay House Drain �--R pair House Drain Lay Main , Other , for
f occupancy or use, with , acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE( , /NOUSTR/AL ASTES 01
OR(1 Connection will be made with X
work to be in accordance with Town of South. Windsor standards,a//OSHA requirements and the conditions
indicated on,the back of this permit.
c�
Proposed start date / Estimated time for completion
Permit is to be issued to �, s!, t the holder of Drain Layer's License No.
OtO' 2Z*V I Z--:- Only holders P 1, P7 & W9 licenses will be issued permit. Permit will.expire thirty (M
!= days aher 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 S"7Excavation Permit No.
and/or ConnDOT Permit No.
Signed /-r-L
L/censed Drain Layer
ffi/WUSE0=111L,Y
Permit Fee Paid$cR5 .ao (Check No.) 15 ci'
Y Connection Charge $ 6 4c, " (Receipt No.)(- t5 c Dated 7-25=9 C-,
Insurance on File (V/( 1
Bond on File (v) This permit is hereby issued to the above named Drain Layer who has a valid
rcense issued by the State of Connecticut and has on file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
/ntertown Agreement ( 1 (►
Record of Sewer. �'u, /�b
Assessment ( 1 ( 1 Issued by Date
INSPECTION
Date Work Started S Date Completed gZ.— Q
Comments
APPROVED:
Insper6tor Date