HomeMy WebLinkAboutDrain Layers Permit 15 Baker Lane IFT
TOWN OF SOUTH WINDSOR
TMENT OF PUBLIC WORKS
BU U OF POLLUTION CONTROL
'A DRAIN LAYER'S PERMIT .621 O
192Z'"R c
'Pu suant written application,- permission is hereby granted to the
,!L ce s d ai7 Lay rt. naim herein to perform the work indicated ;below at
� at premises own d by
whose address is b , to
Lay House Frain, Repair se Drain, Lay Main,' ` Other
for F Al occupancy or use, with 1 ,e
I. Family Uni , with �V2, acres.
Type of: Sewage to-,be', :connected under this permit : `°SANITARY SEWAGE ( ,
INDUSTRIAL WASTES
Connection will be made with SQL 33 5'rdUe/ .,,'dam
Show sketch ofproposed work or furnish 'two (2) copies of separate drawings.
O HA REQUIRFFMENTS M ST B F LLO J
SPECIAL CONDITIONS
Desired Starting Date / Estimated Time for Completion
Permit to be iss d ue to
��r�es
the holder of Drain Layer' s License No. :7g15rj,1_. Permit will exo-iret thirty'
(30) _days after date of .issuance The. undersigned Drain Layer. hereby agrees
to all the terms and conditions . set . for`th in the permit and the reverse side_
thereof.. Applicant has 'received Town. Permit No. and/or_
CHD Permit No.
Signed
Lice (id D in Layer
The abryove named Drain Layer has a va - d .lice se iss9d. by ,the State of
Connecticut and has filed a satisfactory_ and and insurance policy in the
name of the Town of 'South Windsor:
Engineering Dept. Date
Permit Fee Paid $ .., Check Number Gjf e�
Connection Charge Receipt No. _ 4. 506 Dated 2,1
Issued by
INSPECTION //
Date work -started ���-z3-9 Date completed / I/-
Sufficient notifica on rece e : Yes No
Special Conditions
APPROVED: A 64/ -Z � -
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
i
INSPECTION REQUEST
DATE OF REQUEST: f �� / T TIME:
BY: FOR LOCATION:/g � -
DAY INSPEC. NEEDED ! �a / T TIME:
TYPE OF INSPECTION:
( � ) SANITARY/LATERAL (PERMIT NO-N?, /Q ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: Z �- �"' TIME: 51,00 INSP:
CONTRACTOR: WEATHER: Q e
WORK IN PROGRESS:
Ag
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: