HomeMy WebLinkAboutDrain Layers Permit 0436 Avery Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 00
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.Pursuant to written application, permission is he eby granted to -he
Licensed Drain kayer, named herein to perform th-e work indicated below at
at premises owned by ,i►_ ti l
whose address is InWand to
Lay Hous� Dra#n, Repair House Drain, Lay Main, Other . . ,
for ' 110,5� c1�_� �, occupancy or use, with
Family Units , with acres.
Type of Sewage to be connected under this permit : SANITARY SEWE
INDUSTRIAL WASTES ( ) : OR
Connection will be made with —S�n 5' r),
Show sketch of proposed gvork or furnish 'two (2) copies of separate drawings.
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REQUIREIJENTS MU.
jT BE FOLLOWED
"SPECIAL CONDITIONS
Desired Starting Date 11 Ay Estimated Time for Completion u Au
Permit_ to be issued to r- W-9—
.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 aA 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
Lice7'0nse Drain Layer
The above named Drain Layer has a vale, license issued by the State of
Connecticut and has filed a satisfactory on and ins ance - policy in the
name of the Town of South Windsor:
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�nO neeri Dept. Date
Permit Fee Paid $ a5 .nQ Chec jNmber Q ( R-►O_gAj
—
Connection Charge Receipt No, _ gip ated 7 9-Yl/mow.
Issued by lU�.
INSPECTION
Date work started Date completed
Sufficient notificuion receiv'—e3: es No
Special Conditions
APPROVED:
Inspector Date
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SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
3 �
DATE OF REQUEST: !Ld! TIME:
BY: FOR LOCATION: v
DAY INSPEC. NEEDED TIME: d
TYPE OF INSPECTION:
( � ) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP:
CONTRACTOR: ����d7G %��i�02cciL ' WEATHER: �c--
WORK IN PROGRESS : 13 X,)
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
Y:
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