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HomeMy WebLinkAboutDrain Layers Permit 21 Baker Lane - ,.- 1. T,. .- „-,w-..nvt'- :'� n `f� `f'�"`�++�"TA�`,"„`�y„c� .c:" ,. ,"r, : f• , TOWN OF SOUTH WI N DSOR DEPARTMENT OF PUBLIC WORKS UREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT - 228 Z—2— Z. 19 , Pursuant to written application, permission is hereby granted to the Liceryse rain ayer named herein to perform the work indicated below a 0 at remises owned by whose address is $ to La y House D ,a in Re air y ouse Dra n La Ma in, ain P . Y � for / occupancy or use , with Family Uni : , 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 FOLLOWE SPECIAL CONDITIONS�/I�.L'� S'fJt"�lf DLO ,�E�,�i�l1�,E,cdy Desired Starting Date -- Estimated Time for Completion Yj Permit to be issued to hJ7 the holder of Drain Layer ' s License No . z0$g�0 . Permit will expire thirty ( 30) days after date of issuance. The undersigned Drain _Laer hereby agrees to all the terms and conditions set forth in the permit and the reverse side thereof . App.li"cant " has received Town Permit No . and CHD Permit No . Signed- ' Linro ed ain Layer The above named Drain 'Layer has a vali liceni- s ed by the State ofConnecti ut and . has filed a satisfactory and and ante policy in the name of the Town of South Windsor : j Enginee i Dept. Date Permit Fee Paid Chec N mber Z Connection Ch,arge Receipt No. �ZZ ated /�12zfg , Issued by INSPECTION Date work started -- Date completed / � 4-- Sufficient notificaT=-received: -yes No Special Conditions APPROVE nspector- Date SANITARY LATERAL & EXCAVATION PERMIT Q INSPECTION REQUEST DATE OF REQUEST: TIME: D BY: ?,,cw FOR LOCATION: J Bapooviro js� DAY INSPEC. NEEDED 4l]� TIME: � Wl TYPE/OF INSPECTION: / (� ( /) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN ( } EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE:- - TIME: 2- © INSP: CONTRACTOR: WEATHER: ° WORK IN PROGRESS: l AREA OF CONCERN: SPECIAL INSTRUCTIONS: