HomeMy WebLinkAboutDrain Layers Permit 0125 Avery Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6 017
� 1 19 ?7
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
1,.?S '04ycna ��- at premises owned by L?a. lij ,�,rv+ E4:_ ; • , .�
whose addre s is _ � ; ti i .��,,4 '� Yr! � 4- and tq
Lay House Drain, Repair -House Drain, Lay Main, Other ,.
for 14'1i' ,`, -� , occupancy or use, with
Family Units, with 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 (2) copies of separate drawings
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIALCONDITIONS
Desired Starting Date Estimated Time for •Completion �� � .:,
Permit 'to be issued to Ili; !,_ f <r —
the holder of Drain Layers License No. '.laCa a�t1["� 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 7L
�f j
Licensed Drait4 Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory bon and insurance policy in the
name of the Town of South Windsor:
z� f�3
J�•UC7 ng, nee i Dept. Date
Permit Fee Paid $ )0 Check ber
Connection Charge Receipt No. fDjted =- C'
Issued by -. /f�- / J
\�7
INSPECTION .�
Date work started Date completed
Sufficient notification ece ve es No
Special Conditions
APPROVED:
Inspector Date
'
TOWN OF MANCHESTER
BOND PUBLIC WORKS DEPARTMENT ��i
Application Date
Amt. Req. �� _
Permit No. q
Am't.onFile LINCOLN CENTER
Permit work and/or temp work to be
MANCHESTER
Date of Expiration , CON N ECTICUT completed by
APPLICATION FOR PERMIT Permit expires
FEES
Permit pending the circled Dept's approval
Permit Fee $ Dept. Signature
Call 1-800-022-4455
Perm. Repair Pay.$ Engineering Before You Dig
Maintenance Fee $ Water and Sewer C.U.U.P.P.Ticket No� 3353_�o
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Name and address of applicant S r UeS �-etL oniS :�?Aoc_l
c� s 11%4i tK� Phone No. Y/i 41 Emergency Phone SS
Location of proposed work ue✓t,-
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Describe fully nature of permit re uested UJ2 �0_k w! i S'
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Insurance on file with town Ctihyes ❑ no Date policy expires
° Name of Insurer Cr c
/ l93 Approximate time for completion �—�-��-d S Desired starting date J a
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a Show sketch of proposed work or furnish 2 copies of separate drawings
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1 agree to furnish the Town the amount of bond or fee required and to reimburse the Town for any expenses incurred by the
Town for maintenance or repair wory in connection with this permit and that I am familiar with and will abide by the
regulations for permi outlined n the Town of Manchester's Permit Manual st revisi n.'
Applicants n. Date Approved by 400 Date Agala
FOR INSPECTOR: Date work started
Expected date for permanent repair Material slips attached ❑ yes ❑ no
Unusual conditions encountered
Date completed Signed
Inspector
SANITARY LATERAL & EXCAVATION PERMIT
" INSPECTION REQUEST
DATE OF REQUEST: Ci \ a�Q TIME: a 2�
BY: � �, �e��� FOR LOCATION: 42g5 SA -
DAY INSPEC. NEEDED (ho n TIME: to'-o d P�m
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT _NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
d
DATE: - 2 7 - 9� TIME: /p ! o d INSP: r
CONTRACTOR: t�� �, �,P WEATHER: jt,44
WORK IN PROGRESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: