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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT6 192
-99
Pursuant to written application, permission is hereby granted_.to ,the
L ' censed Drain Layer named herein to perfo m th"e work indicated below a.t-
j
20;r at premises owned by
whose address is Tll<✓ and to
Lay House Drain, _ >4 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
Show sketch of proposed work or urnish 'two (2) copies of separate drawings.
�.
E' pi2. .
` OSHA R REM QUI ENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired. Starting Date T_p -1j4 Estimated Time for Completion
Permit to be issued to J *"N 5k4T V_ Gwsi
the holder of Drain Layer' s License No. Permit will expire thirty
(30) days after date of .issuance_. The undersigned Drain Layer hereby .agrees
to all the .Xerms and conditions set forth in the perm t,and the reverse side
thereof . can has, ree i d To- a :Perini o. and/or
CHD Per it. 'ca . r ,.Z,'
,Si,gned.
`'L tensed Drain Layer
The above named Drain Layer has a va d license issued by -the State of
Connecticut and has filed a 'satisfact ry and and insurance policy in the
name of the Town of South Windsor:
ngi ing Dept: Date
w AL' j
Permit Fee Paid $ Ch Number �T q 9
1.
Connection Charge. Receipt No. d"9 q A Dated
' Issued by Idl
INSPECTION
Date work started Q Date completed}:
Sufficient notification receive es No
, Special Conditions
APPROVED: a, /4--6-/
Inspector Dates