HomeMy WebLinkAboutDrain Layers Permit 042 Austin Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 2 6029
41(� Iva n Cl.Mc 42, ._ , 19 �/ J
Pursuant to written application, permission is hereby granted to the
Lieens�ed .1)rain Layer named here p to perform the work indicated below at
9 %,e at prem ses owned by 3`
whs oe address is S S ,
Lay House Drali , Repair House D ain, Lay Main, d tQ
for Qther ,
occupancy or use, with S/'fir;
Family nits, ith lf� 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 'two ( ) copies of separate drawings.
-93 6XAi�A IZ4,-1 �40"f m6ft
XW ef�
SPECIAL .CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Datec>estimated Time for Completion p
Permit to be issued to i� y C�
the holder of Drain Layer's License No. 2.,offq 4aPermit 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 -7,7__ gJ
Licens' d Dr Layer
The above named Drain Layer has a valid licens issu by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
_LL,,AA";U-1j 101//'� �t
n ,Bing Dept. Date
Permit Fee Paid $ 2--S ,00 Check mber r3p�
Connection Charge Receipt No. Dated
Issued by
INSPECTION
Date work started 3 Date completed 1U-Z'r,-`3�
Sufficient notificaE n rece ve es No
Special Conditions
APPROVED:_
Ins ect r Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: �� r � 93 TIME:
BY: FOR LOCATION:
DAY INSPEC. NEEDED JO ZO -/ J TIME:
TYPE OF INSPECTION: n
{ SANITARY/LATERAL (PERMIT NO. �O _) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: is/�� /r �' TIME: /D •ado INSP:
CONTRACTOR: — WEATHER: 3 At y
WORK IN PROGRESS:110
r
s
''
WV /
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST:.... /ob s TIME:
BY: FOR LOCATION: �ed �e�� �a� prA
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
{ ) SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: a-0 INSP: �
CONTRACTOR: �l�YJ WEATHER: A/klG -
WORK IN PROGRESS: oZe
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: