HomeMy WebLinkAboutDrain Layers Permit 1 Amaryllis Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
' BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT No 5 917
, 19 j3
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indi ated below at
w,Ae u I/1*j 4,10Av,E at premises owned by �
whose address is ' go and to
Lay House Drain, __Repair House Drain, Lay Main, Other ,
for lz,.11 / occupancy or use, with
Family Units, with a res.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with , TV C_
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer' s License No. o?C�� Z>� 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.
r
�ijg
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 :
Engineering Dept . Date
Permit Fee Paid $ o�5 � Check Number
Connection Charge Receipt No. Dated
Issued by
INSPECTION
Date work started —z ",9v Date completed 3
Sufficient notifica on rece ve : es No
Special Conditions
APPRUM
Inspec or Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: Io-II-9I
BUILDING ADDRESS OR LOT N° : 1
STREET: AmARYL.UIS -LAWS
SUBDIVISION: pe"beso
Mi STATION : y + 83
NORTH ARROW INVERT ELEV: 11S. 1r
-71.25
TIE JL
TIE
FT. FT.
HOUSE LATERAL _ HOUSE
CONNECTION STUB STUB CONNECTION
FT. I1 �.lb s 7 7 FT.
BUILOING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) (IFEXIST.)
tI't'�5 TIE TIE
roaiidb k4io C623 5i►�. IWO �T.�13.5
,59, �= 5
W STATION : + �0
Font 46 omit1 tMOEXT
(sew�t�� I �tNk66� INVERTELEV: 116 •o.l
t6 IDFf' ccr>5i. R $c EXc rrJ A TI orl
CoWN P,tE�D R� C9P.�(� f-I�kNa _ BQa►� >��t1�.o�7z5
CONTRACTOR (PRINT) NAME F CONTRAACT RCS SUPERVISOR (PRINT)
C0-1 zwltr RL c Rcc,E L-• to-Z�_q1
�► I 17o C14Ko�1N� R�.
STREET. ADDRESS SIGN ATtkWE DATE
5. W t -)05t) P/ 6caRAH CT
TOWN STATE ZIP INSPECTED BY TOWN DATE
zn3 ) 5Zt-7323 z SS�-,Z561
TELEPHONE NUMBER #
WFIIT'Z---TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER