HomeMy WebLinkAboutDrain Layers Permit 115 Beldon Road Armw
�•- TOWN OF SOUTH WINDSOR
DEPARTMENT-OF PUBLIC WORKS
BUREAU OF POLLUTION'CONTROL
DRAIN LAYER'S PERMIT 142 6251
Pursuant to written application, permission is hereby granted to the
Licensed..Dr a * Laye named herein to perform the work indicated< below//at
t; ;Vn Pr) premises owned by /�'j7" �,Of�Sto
whose a dress is O S LO act to
Lay House Drain, Repair Ouse Drain, Lay Main, Other
for occupancy or use, with
Family Units Vwithacres.
Type of Sewage to be connected under this permit : . ' ANITARY `SEWAGE
INDUSTRIAL WASTES ) . ' OR ( )
Connection will be made with
Show sketch of proposed'work or furnish two (2) copies o separate drawings .
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS p, - 02- -40
Desired Starting Date 95'" Estimated Time for Completion
Permit to be issued to D -J,C_&(>
the holder of Drain Layer' s Lice' No . Permit will expire thirty
( 30) days afterdate 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/off
CHD Permit No .
Signed
Lice s d Dr in Layer
The above named Drain Layer has a val d licen iss d by the State of
Connecticut and . has filed a satisfactory and and insurance policy in the
name of the Town of South Windsor:
E g n ng Dept Date
Permit Fee Paid $ `.OU Che k Number �c-. R10 <-153�1
Connection Charge Receipt No. ate
Issued by .3 Z7 J
INSPECTION
Date work started Gf-p"� — 6_� Date completed
Sufficient notification received: des No
Special Conditions
APPROVED: ] tl�
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST:� TIME:
BY: ��pr, No,o, c,� _S- FOR LOCATION: c�-f I �e u� ►�c1 ,
DAY INSPEC . NEEDED TIME:
TYPE OF INSPECTION:
SANITARY/LATERAL (PERMIT NO. h251 ) ( � ) FOOTING DRAIN
( �` ) EXCAVATION (PERMIT NO. ) ( } OTHER
INSPECTION REPORT
DATE: �{—oc, - g 5/ TIME: �'a� INSP:
CONTRACTOR:— (/ Al') WEATHER:
WORK IN PROGRESS:
/ooi-ll>ii T)�Z lti GyC�/�-1 lB+y /S ,5 ,i/li ,-
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: