HomeMy WebLinkAboutDrain Layers Permit 114 Ridgefield Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5923
114 3 (o , 19 %3
d
Pursuant to writt pp. cation, permission is hereby granted to the
Licensed Drain Layer namedherein to perform the work indicated below at
at premises owned by /A6nUr4 Cns4
whose address is (;)P7�4&eC FIE Ln 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 ( ) ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with (o`` pk c
Show sketch of proposed work 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 ytilL y Cok 0
the holder of Drain Layer's License No. 2-a, 91 � 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
Lice n 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:
Engineering Dept. Date
Permit Fee Paid $ 00 Check Number
Connection Charge Receipt No. Dated y 'C�
Issued by
INSPECTION
Date work started Date completed
Sufficient notification rece ve : Yes No
Special Conditions
APPROVE
Inspector Date