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HomeMy WebLinkAboutDrain Layers Permit 5 Amaryllis Lane TOWN OF SOUTH WI N DSOR " DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT 5921 19 Pursuant to written application, permission is hereby granted tothe Licens d Drain ayer named 77(1.1 ein to perform the work indicated below at /�! r w � b T at premises own d by -l.-c" d� /r✓/ 5 , whose address is A,I -1 � / and to . Lay House in, Repair House" Drain, Lay Main, Other , for ;//11 occupancy or use, with Family Units, w th (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 ll'two (2) copies of separate drawings. SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED Desired 'Start ing Date Estimated Time for Completion Permit to be issued to /.t/ 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. S i geed / --•- 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 $ 2` r Check Number Connection Charge Receipt No. } �"/ z-1� Dated Z3-S`j Issued by l' INSPECTION Date work started - '"' 0-15 Date completed Sufficient notification rece ve : dyes No Special_ Conditions APPROVEU4-,;(�406h� � pr9 nspector Date "� r 'r t� TOWN OF SOUTH W I N DSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS OR LOT N° : STREET: hMa1Z.1U15 'LPfA6 SUBDIVISION: NH STATION : _a+130 . NORTH ARROW INVERT ELEV: 12fo. (D i 100.g TIE TIE FT i FT. HOUSE LATERAL LATERAL HOUSE CONNECTION STUB STUB CONNECTION FT. 21.0 4 FT. BUILDING INV. ELEV. INV.ELEV. ` 1= INV. ELEV. INV. ELEV. (IF EXIST.) 5�.FC y_z`. � BUILDING ttBGS�. (IF EXIST.) Focru+b �r+a.(Pt.;�-off 77.�0 TIE �, TIE 4S`tFCf S�/c 'ta�3 - NH STATION :_1I_+�¢v C.B.L3 SiA. I t to c+' iir<.y3 1 iNJ. ©uT=i13.S 2�`Fc�$•9 INVERT ELEV: tcs�Irty It�t1. Its = i1y.5f5 �O�ilNl�fp� Ca Erltl �D bG ,cc��R�nor1 6�6- gftNHK- &OeDAI " L0a25 CONTRACTOR (PRINT) NAME F CONTRAC . SUPERVISOR (PRINT) G-1 shl,-r wc.c'. tzar- 1,20 ��kau>y6 j , �7g;; - /0-ZS Z/ STREET.ADDRESS SIGNATUR DATE TOWN STAT ZIP INSPECTED BY TOWN DATE 2a3 ) 5z8-73Z3 �59-ZS61 TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER