HomeMy WebLinkAboutDrain Layers Permit 111 Spinners Run TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6001
- �- 19
Pursuant to written application, permission is he eby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
Z/l �S i I�iJE/ZG ) A-) at premises owned by
whose address is 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 61, PUC
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 j
Permit to be issued to ! r
the holder of Drain -Layer's License No. d2 d 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
Licensed Drain ayes
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:
E gin ing Dept. Date
Permit Fee Paid $ �JA-UCH Check umber 3 (j
Connection Charge Receipt No. � Dated
Issued by \ 1
INSPECTION
Date work started S �Z � Date completed 8
Sufficient notification receive es No
Special Conditions
APPROVED:
Inspect r Date.