HomeMy WebLinkAboutDrain Layers Permit 79 Steep Road (2) TOWN OF SOUTH WI D N SOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT '`
t IL. t 19 ,
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work in4,�cated� below at
at premises owned by
- , , i
whose address is r r
v is 0 Land 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
Show sketch of proposed work or furnish 'two (f2) copies of separate drawings.
( ! : IFS!"1 A
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date j ;' ` Estimated Time for Completion
�.,.
Permit to be issued to
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 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 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:
r :
Engineering Dept . Date
Permit Fee Paid
$ Check Number
Connection Charge Receipt No. Z,- ,.. , Dated -�
Issued by
INSPECTION 2
Date work started J Date completed S�o9'9.3
Sufficient notification rece ve : yes No
Special Conditions
APPROVED:
nspector Date