HomeMy WebLinkAboutDrain Layers Permit 0710 Avery Street ...... -. ... .:...-w^�r.V-.a.-w^}..r.��F"..-.`-' +'AZ*)t 'f��w"'`.�.�T•e- .. �J,.Zf9•S- y,�
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L. TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT '
Pursuant to written application, permission is hereby granted to the
Licen Dr in Layer named herein to perform the work indicated below at
f at premises owned by:
whose address i and to
Lay House Drai , Repa r House Drain, Lay Main, Other ,
f for �'C4S►' /� occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE (.)d) ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of pfvposed work or furnish 'two (1) copies o se t.6arate drawings.
2]
4p SH� RE UIREENLMUST� E FO OWED
SPECIAL CONDITIONS r r c � O tQ !L-S ,14 tme-
Desired Starting Date Estimated Time for C o mp 1 e t o n3,0,jvtJTq
Permit to be issued to j r,wa, f
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 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
4=iceln:�Qsed Drain Layer
The above named Drain Layer has a valid license issued by the. State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the` Town of South Windsor:
/Z /9,4-
n ine ng Dept. Dane
Permit Fee Paid s: ZS',do Check mber ZZ43
Connection Charge Receipt No. _4=1 Da ed 6-.2,7--q
Issued by �lz�
INSPECTION
Date work started O "/ Date completed
Sufficient- notifica n r ceiv es No
Special IC ndit ions `-^�
A V`ED 7
Inspector Date
1
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TOWN OF SOUTH WINDSOR `sx
SANITARY SEWER LATERAL FIELD LOCATION '
i 3
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' :
STREET: A Uw,f`y
SUBDIVISION:
(:D
*4 STATION : +
NORTH ARROW INVERTELEV:
TIE TIE
FT. FT
HOUSE LATERAL LATERAL MOUSE
} CONNECTIONT STUB STUB CONNECTION
�1
FT.
-FT.
K BUILDING IN . ELEV. INV. INVU. . ELEV. INV. ELEV. BUILDING
(I F EXIST.).,
(IF EXIST.)
TIE TIE
NH STATION : +
INVERTELEV:
Jam ta-e,
CONTRACTOR (PRINT)1 NAME OF CONTRACT RCS SUPERVISOR(PRINT) l
Ol v JU �/
STREET ADDREYSS IATURE DATE
0,
TOWN STATE ZIP INSPECTED BY TdWN DATE
l / ) orj
TELEPHONE NUMBER
N WHITE - TOWN P IK - CONTRACTO ' Y41LOA-CONSULTING ENGINEER/DEVELOPER
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: Z . G TIME:
l
BY: JFOR LOCATION: -7/O
DAY INSPEC. NEEDED 3C�( L TIME: !f�`
TYPE OF INSPECTION:( SANITARY/LATERAL (PERMIT NO. 64 { ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
2:v 3 ; od
DATE: 361 _ �} TIME: �;�� //,'3 f7 INSP:
CONTRACTOR: �;,�,,,�iZ, �fc�9t,d`u1� WEATHER: go
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WORK IN PROGRESS: lo
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t
SPECIAL INSTRUCTIONS:
A
p 111