HomeMy WebLinkAboutDrain Layers Permit 0444 Avery Street {
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Y 6163
Pursuant to . written application, permission is hereby granted to the
Licensed Drain Layer n me.d herein to perform the work indicated b low t
!� 1 at premix s owned by �� A- ,� "
whose address is n'L � a nfd to
Lay House Drain Re air House D ain, - Lay Main, Other
for / A.,, { ,�- occupancy or use, with —�-
Family Units , with---nacres.
Type of; Sewage to he connected under this permit : SANITARY SEWAGE ( ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furnish� tw opies of separate drawings.
BE FOLLOWED .
SPECIAL CONDITIONS
Desired Starting . Date Estimated Ti a for Completion 1 ,04
Permit to be issued to/ d
the holder of Drain Layer's License No. Permit will expire thirty
(30) days after date of issuance. The un ersigned Drain Layer Ihereby agrees
to all the terms and conditions set forth in the permit: an the reverse side
thereof . Applicant has received "Town Permit No. and/or
CHD- Permit No.
Signed WAJ�A
i certseU Dr Layer
The "above named Drain Layer has a valid l cense i rue y. the: State of
Connecticut and has filed a satisfactory bond and insu a policy in the
name of the Town 'of South` Windsor:
9`1
Engineering" Dept . Date
Permit Fee Paid $ Check Number
Connection Charge Receipt No. /V Al 7� Dated 4.
Issued by
INSPECTION
Date work started' L / L Date completed - � -
Sufficient notification eceivea :�_�yes No
Special Conditions
04
APPROVED•
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
TDATE OF REQUEST: 9� IME:
BY: - 1��,/� L ��'--Y FOR LOCATION:
' DAY INSPEC. NEEDED `� 9-%Q'T� TIME:
TYPE OF INSPECTION:
SANITARY/LATERAL, (PERMIT NO. FOOTING DRAIN
{ ) EXCAVATION (PERMIT NO ) ( ) OTHER
INSPECTION REPORT
DATE: - TIME: D :O 6 r INSP:
CONTRACTOR: WEATHER:
WORK IN. PROGRESS:
:;:L ,ale-
AREA OF CONCERNS
SPECIAL INSTRUCTIONSz