HomeMy WebLinkAboutDrain Layers Permit 3 Amaryllils Lane TOWN Of SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 2, 5922
?, i\-k , 19, 13
Pursuant to written application, c
pp , permission is hereby. granted to the
Licensed Drain Layer named herein to perform the work indicated below at
LET= 1:�I 7 I ' 6o---e at premises owned by
whose address isf _?0 7 -7FG6-u�✓ 51� � .�(�/r�%rJ�G and to
Lay House Drain, Repair House Drain,, Lay Main, Other ,
for ,� l occupancy or use, with
Family Units, with ores.
Type of Sewage to be connected under this permit : SANITARY SEWAGE &A
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
/A) S
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date 3 Estimated Tlme for Completion
Permit to be issued to !Z/ lit//� / �1�-r ./
the holder of Drain Layer's License No. 2 j 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.
S i g n e d
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:
En ineering Dept. Date
Permit Fee Paid $ �,`J Check Number 'mac!'f
Connection Charge Receipt No. Z,0, Dated
Issued by
INSPECTION
Date work started �, -�Z�D gy� Date completed -9 ?
Sufficient notification rece ve : �,....-Y'es No
Special Conditions
APPRO - 3 7io-j3
Inspector Date
SCAN -
TOWN OF SOUTH WINDSOR
' SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N° : # 3
STREET: ArngRyLut> I;kmp—
SUBDIVISION:
Mi STATION :
NORTH ARROW F
V: �15r'��
67•2$
TIE � TIE
InIV6&Cam'FT FT.
HOUSE LATERAL HOUSE
CONNECTION STUB STUB IF CONNECTION
FT. I I (o.92 FT.
BUILDING INV. ELEV. INV.ELEV. ►= INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) (,gzLr TO HCL45E r (IF EXIST.)
�f�j io3.6
TIE O TIE
CIS 23 STA, I 1 00 Li
1NV,(UT= li3,y'
��F��.i`Ie 33�F •`
i�a! itf�•4if Ml STATION :
Fo�t,av our.+ b
INVERT ELEV: :1_l,
�rLOt,� CDTIST. A��E�CI�JR'SICvJ tN d lri=t t'i•�t
�A (, R4R (�ug>= (9REC� Y1�t�rl>rIC.$ream ,f31�,>.0�25
CONTRACTOR (PRINT) NAME F CONTRACTO S SUPERVISOR
(PRINT)
"I *I gT- MAk.0 CI RCLE 1 .6 cAeow� 12P. 10 Zq-q!
STREET ADDRESS SIGN—ATURt DATE
S. mi'D.50 CT . �z,2�� C,7.
TOWN STATE ZIP INSPECTED BY TOwN• < DATE
--03 ) 5Zt-7323 / 951-Z561
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW —CONSULTING ENGINEER/DEVELOPER