HomeMy WebLinkAboutDrain Layers Permit 39 Barbara Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 , 6241
� . .70 l g
Pursuant to written application, permission s hereby granted to the
Licensed Dr in ayera ed. herein to perform the work indi a ed el w t
39 r at remises owned by ( �
whose address is and to
Lay Ho a D in, epair House Drain, Lay Main, Other
for r occupancy or use,- with
Family Units , with acres.
Type-- of Sewage to be connected under this permit : SANITARY SEWAGE ) ,
INDUSTRIAL WASTES { ) . OR
Connee,t'ion will be made with
Shosketch of propose rk fp-refurnish two (2) copies of separate drawings.
ILI Pf OF
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date AJg5' Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer ' s License No. 2-0 Permit will expire thirty
( 3''D) days after date of issuance. The undersigned Drain Layer hereby agrees
toa- 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
Licensed 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 Townof South Windsor:
30 r
Engineering Dept . Date
Permit Fee Paid $ � 5, O O Check Number d
Connection Charge Receipt No. 9-52. 7 �11e Dated
Issued by 4
INSPECTION Q
Date work started - a Date completed
Sufficient notification receiv,ed':. j—�es No
Special Conditions _�.�
oe
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
._ INSPECTION REQUEST
DATE OF REQUEST: / 9 4- TIME: 2 " 00
BY: q�,,�, �{JL�-G(� FOR LOCATION:
DAY INSPEC. NEEDED / - j — 9 T TIME: A /h ,
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT NO.-6 Z ' } ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT .NO. ) ( ) OTHER
INSPECTION REPORT
�a: 30
DATE: / - _ j -9 - TIME: 9 ; o c� A,.vt. INSP
CONTRACTOR: _�� WEATHER: Q.L,4 . 3 $ °�
WORK IN PROGRESS: C
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: