HomeMy WebLinkAboutDrain Layers Permit 128 Rimfield Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
o DRAIN LAYER'S PERMIT 5992
}�' , 19�
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named re to perform the work indicated below t
at premisgs owned by1 .T Coh S
whose address is GJ to_
Lay House Drain, Repaiv;'Housdi Drain, Lay Main, Othe ,
for occupancy or use, with
Family Unit , with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ( uj
INDUSTRIAL WASTES ( ) , OR (
Connection will be made with
Show sketch of proposed ,work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date 3 Estimated Time for Completion , '
Permit to be issued to 3w1gA
the holder of Drain Layer's License No. 46,5e3o 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 -" G5
Licen d Drdlu 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:
--7Ejg1:n-q,r& ng Dept . Date
Permit Fee Paid $ o d Check,,_Number,
Connection Charge Receipt No. 3 4 : Dated
Issued by
INSPECTION J'
Date work started v �g3 Date completed
Sufficient notification rece ve : es No
Special Conditions
APPROVED:
Inspector7
�„ Date