HomeMy WebLinkAboutDrain Layers Permit 15 Apple Tree Lane TOWN OF SOUTH WI N DSOR
' DEPARTMENT OF PUBLIC WORKS
` BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT '
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Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work ndicated below at
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at premises owned by� m 0r� �
whose address is
Lay Hose Dra Repair House Drain, and to
for --'(��-- Lay Main, Other
Family Units,with acres. occupancy or use, with
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 two (2) copies of separate drawings.
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SPECIAL CONDITIONS NoYVXI . Apq1, �Y e
Desired Starting Date c),J7 g U Estimated ime for Completion 0-,,, 7 I`S O
Permit to be issued to J v ,
the holder of Drain Layer's License No,aOLT
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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 VIA
1
Licensed Drain Laye
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:
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Engineering Department Date
Connection Charge Paid Permit Fee: Paid $
Check Number
CWED
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: 905
Inspector pa e
TOWN OF SOCITH~ WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: _ 7 N0L / < F6
BUILDING ADDRESS OR LOT N' : 1�
STREET:
SUBDIVISION:
Ml STATION : z2_+_ _,6
NORTH ARROW INVERT ELEV:,
yl -l0
IE TIE
4J.er�
ACONNECTION
4
-FT
_ __ LATERAL
LATERAL HOUSE
STUB — --_
�/. STUB CONNECTION
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INV. V. INV.ELEV, F= INV. ELEV. INV. ELEV. FT.
� BUILDING
(IF EXIST.)
TIE
(� TIE
NH STATION : 1 + f .a
INVERT ELEV:
X - ] s rQ W/,
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
STREET ADDRESS ZSN U E
DATE
TOWN STATE
ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER SCANNED
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER