HomeMy WebLinkAboutDrain Layers Permit 310 Beelzebub Road f TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ! 6074
a , 19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Lay ream d herein to perform the work indi�at.ed belo at
3/O at premi e:s owned by S;<} - G��` .v,�
whose address is It ,� ,z1 f..J. and to
Lay Hose �r in, Repair Rouse Drain, �- Lay Main, Other _ ,
for , �, — occupancy or use, with
Family Units, 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 REQUIREMEN
SPECIAL CONDITIONS TS MUST BE FOLLOWED
Desired Starting Date Estimated Time for Completion
Perm,tf "to a Aissued to -�--
the hold, r BoaiW, Layer's License No. PD V U \-ja Permit will expire thirty
(30) deys to dat„e of issuance. The undersigned Drain Layer hereby agrees
to all jhe CRe'r%1 and conditions set . forth in the permit and the reverse side
thereof; Vp�.ieant� has received Town Permit No. and/or
CHD Peri t Ub, , - h CU--� rc�.
uary qy' 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 Town of South Windsor:
Engineering Dept. Date
Permit Fee Paid $ Check Number
Connection Charge Receipt No. Dated f --! - �
Issued byDit%iv'i�
INSPECTION
Date work started r"Z 5 0 / Date completed �� �- 9�
Sufficient notification received: `_ es No
Special Conditions
APPROV J
I Spector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: - TIME: II : �®
BY: FOR LOCATION: 3I4
DAY INSPEC. NEEDED { TIME: � `'p a
p, -
TYPE OF INSPECTION: "
( K ) SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. �'t9d ) ( ) OTHER
INSPECTION REPORT
DATE: '' z (p TIME: _ . 0 INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS: r
I
it
(( 4 f
94 ,ClO
9 4-
AREA OF CONCERN: CxV
SPECIAL INSTRUCTIONS: