HomeMy WebLinkAboutDrain Layers Permit 86 Steep Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITM 5999
69- C . 19
/ Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer �amed herein to perform the work in pc tech bajov at
at premises owned by p rt
whose address is Or" and to
La House Dr in _)o Repair Hou a Drain, Lay Main, Other
for LO occupancy or use, with
Family Units, with acres.
I
I Type of Sewage to be connected under this permit: SANITARY SEWAGE (3e) ,
INDUSTRIAL WASTES ( ) , OR ( .)
'Connection will be made with O
gtnn
Show sketch of proposed work or furnish 'two (d2 copies of separate drawings.
P
N
SPECIAL CONDITIONS OSHA REQUIENTS MUST BE FOLLOWED
Desired Starting Date ' Esama ed Time for Completion
Permit to be issued to ►rUi
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 va13 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:
Engine'ering Dept. Date
Permit Fee Paid $ Z - U, Check Number ` ZZ4f
Connection Charge Receipt No.
3 Dated -S".•-
Issued by
INSPECTION _ 2
Date work started �"�j� Date completed t? -93
Sufficient notification received: es No
Special Conditions
SCA'INNtu APPROVED:
nspector Date