HomeMy WebLinkAboutDrain Layers Permit 57 Alison Drive J j
i TOWN OF . SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT NO 5780
-,2 191L
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work ind ' cat b�ow t
_ `� at premises owned by Gr`p� rr l-q-cm r,
whose address s Kam and to
Lay House Drai , Repair House Drain, Lay Main, Other ,
for jep'l ` 4 )a occupancy or use, with
Family Units , with 2 acres .
Type of Sewage to be connected under this permit : SANITARY SEWAGE U/) ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furnish two (2) co s of separate drawings.
/V S
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SPECIAL CONDITIONS Aln"
Desired Starting Date Z Ir�ryc_ F7, Estimat d Time for Completion-1�,,,y Z_
Permit to be issued to l'
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.
PIP �'�i7/ 'lyQl7� Signed
Lice sed Drain Layer
The above named Drain Layer has a val d 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 :
�� �Z�c�7--
EngiTieering Dept . Date
Permit Fee Paid $ 7/J Check Number G
"Connection Charge Receipt No. // / :�3 Dated
Issued by
INSPECTION 7y�/
Date work started Date completed '
Sufficient notification received : es No
Special Conditions
APPROVED:
nspector Date
i
y
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' : r� "I
STREET:
SUBDIVISION:
Mi STATION : +
NORTH ARROW INVERT ELEV:
Sa we l
M
TIE Z�J_ TIE
L> F T. F T.
� HOUSE LATERAI-v LATERAL _ _ HOUSE
CONNECTIONJ STUB STUB CONNECTION
ZFT. FT.1'�k:
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) (IF EXIST.)
ti
TIE TIE
NH STATION : +
I INVERT ELEV:
dim _-.1 e�7' S ne S A rn Lv-e
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT)
STREET-ADDRESS SI ATURE DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER