HomeMy WebLinkAboutDrain Layers Permit Lot 41 Rockwell Cour TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
6008
19 1/3
Pursuant to written application, permission is hereby granted to the
Licensed Drain ayer named here n to perform the work indicated below at
U at premises owned
whose address is S' r y G S�r�
Lay House Drain, Re air, o G JI _a a to
P use Drain, Lay Main, Other for CAM Occupancy use, with �
Family Units, with _�/ acres. Sig
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of separate drawings
Gl
SPECIAL CONDITIONS
OSHA REQUI}2EMENTS MUST BE FOLLOWED
Desired Starting Date Estimated Time for Completion
Permit to be issued to S;-� `- __ C
QU '
the holder of Drain Layer's License No.
?G 3o . . :�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.
CHD Permit No, and/or
Signed
Lice d�Dr n Layer
The above named Drain Layer has a va d license issued by the State of
Connecticut and has filed a satisfactory on and insurance policy in the
name of the Town of South Windsor:
E�f:Ufilde g Dept. Date
Permit Fee Paid $ �rU® Check �U*ber
Connection Charge Receipt No. 4_31T" aced /� ''
Issued by ` c �
INSPECTION
Date work started `
Sufficient notification rece v Date completed
Special Conditions — Yes No '—
.APPROVED*
Inspector D,��