HomeMy WebLinkAboutDrain Layers Permit 178 Abbe Road TOWN OV SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
t BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6030
0 1911
Pursuant to written application, permission is hereby grated to the
Licensed Drain Layer named herein to perform the work indicated below at
_ f �3 ? S� t at premises owned by whose address is t�'r, l : 1 .
r ` ^ an- tq
Lay Rouse Dra o --,.-' Repair' House Drain, Lay Hain, Other
for: ` .. -t a occupancy or use, with
Family Uni .s$ with acres.
Type of Sewage to be connected under this .permit:I•NDU SANITARY SEWAGE ( ) ,
`STRIAL WASTES { ) , OR )
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of .separate drawings
f
_ OSHA REQUIREMENT ST BE-, FOLLOWED
SPECIAL
Desired Starting Date
�I 1f G :� Es.timated Time for Completion
Permit to be issued to — .�",�;,fe t r -f
the .holder of Drain Layer's License No. -r Per
will expire thirty
r , t
(30) days after date of issuance: The undersigned Drain Layer hereby agrees
to all the terms and conditions set _ fort.h in the permit and the reverse side
thereof . Applicant has r Vved Town Permit No. and/or
PermitNo. G� '
Signed
L 'cen -ed D in `La. er
The above named Drain Layer has a valid license iss 6-:-may he State of i
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 $ Check Number az
r
Connection Charge Receipt No. A/ e: Dated
Issued by i
INSPECTION - #
Date work started Date completed
Sufficient notifica33on"receive J7 -'Yes No
Special Conditions
7
Inspector D_
TOWN OF SOUTH WI NDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: z 3
i
BUILDING ADDRESS OR LOT N°: , f '
STREET: e
a
SUBDIVISION:
i
a;
WH STATION : +
NORTH ARROW INVERT ELEV:
TIE —'---
TIE
—FT
FT
HOUSE �? LATERAL J LATERAL HOUSE
CONNECTION STUB STUB
CONNECTION
i .
a. FT.
BUILDING Ift ELEV. INV.ELEV. F FT.
INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) ,� � (1f EXIST.)
TIE TIE
r aAM 9
W STATION : +
INVERT ELEV:
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT
STREET ADDRESS .
'IS I GNAT DATE
TOWN STATE — O G, �T
ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE— TOWN PINK — CONTRACTOR YELLOW —CONSULTING ENGINEER/DEVELOPER
SANITARY LATERAL: & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 7 4I TIME: r
BY: 9jG FOR LOCATION:
DAY INSPEC. NEEDED TIME: /O *tf �+
TYPE OF INSPECTION:
O SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: /®- F./— L? TIME: z1 INSP: T_
CONTRACTOR: (`o,,e,-- WEATHER: a� S
WORK IN PROGRESS: /
d3 9,'0oA A4, zL ae� X� A a t
r
o t ® r
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: