HomeMy WebLinkAboutDrain Layers Permit 360 Beelzebub Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 3®9
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
t`Z �Dc. at premises owned by Jcc..e.v.t Mc �:vw.dr►
�e5;
cc c, - and to
Repair House Drain, Lay Main, Other ,
for0.,\ occupancy or use, with�-
Family Units , with \ acres .
Type of Sewage to be connected under this permit : SANITARY SEWAGE (X) ,
INDUSTRIAL WASTES ( ) ; OR { ,)
Connection will be made with �c,5kc�t Gcwar {��
,Show sketch of proposed work or furnish two (2) copies of separate drawings .
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date -,�-/ Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer ' s. License No. :X0(o'5;k 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 ',,,,.,,
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 $ ����d Check .Number o")5
Connection Charge Receipt No . G q Dated S-1-96
Issued .by
INSPECTION
Date work started 0/f Date completed
Sufficient notificotion received : � es __rrL No
Special Conditions —
A��� .�.�t > % ,- �f-
APPROVEDz / j
Inspector Date
X
SANITARY LATERAL_.& EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: --/-95- TIME:: 9'yS
BY: V-11 ��� ��to��C FOR LOCATION: C�
DAY: INSPEC. NEEDED TIME:
TYPE OF -INSPECTION:'
} ` ( SANITARY/LATERAL"- (PERMI711 NO.
EXCAVATION (PERMIT. NO. ) ( ) OTHER
INSPECTION-REPORT.
1 DATE.:, TIME: INSP:
CONTRACTOR-.. rvv�L /�T7L WE'ATHEH:°
WORK- IN PROGRESS:
O� - � GG�I��' i✓ /L� 1=0� �/ii��v i`vG i.�S/J i low
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: