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HomeMy WebLinkAboutDrain Layers Permit 95 Beldon Road y--��(ass..�.:iF'"Y.�,.'+�'^�::'"'.�'�! ''Rf': �d"h���4� "�F# �� �Tfi�,si;��''�;Y`t-fi�}:i.i'�"'.�s'�n?� �).�tj2,i$ntS.sei'b��__ :jt ,i• s. , .,r; +. , TOWN OF SOUTH WINDSOR v DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT x 19 Pursuant to written application, permission is hereby granted to the Li ensed Dr InfL�ayey named hgrein to perform the work indicated below at1 fi Bc /� at premises owned by �121 3 W/1�T I w ose address is , so, s:0—;", an to Lay House Draih Repair H se Drain, - Lay Main, Other , for occupancy or use , with Family Units, iwith l acres . Type of Sewage to. be connected under this permit . . SANITARY SEWAGE INDUSTRIAL WASTES, ( ) ' -OR ( ) Connection will be made with $ h/1 3S se IV /f 02 02 Show sketch" of proposed work or furnish two (2) copies of separate drawings .' OS A. REQUIREMEN S MUST B F LLOWED SPECIAL CONDITIONS G1' ,4p 4 0 .e Desired Starting Date / f -- ff- Estimated Time for Completion / �, Permit to be issued Tto Sd {? J GCR Jttlj the holder `of Drain Lae ' s License No. 2.!'CQ3©• 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 -,, ';° CH'D Permit No . Signed' " License ra aver The above named Drain Layer has a val license ssued y the State of Connecti�ut and . has filed a satisfactory b d on nd insurance policy in the name of the, Town of South Windsor: z Engineering Dept. Date Permit Fee Paid $ ; Od Check Number 106� Z-7 Connection Charge Receipt No. Pat d / - 3 -9 Issued by INSPEC-,TS.ON Date work ;started j- )Q _ 9 S Date completed /0 gS Sufficient notification receivU ; es No Special Conditions APPROVED nspector Date SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: f 1p - 9 S TIME: BY: FOR LOCATION: CAN DAY INSPEC. NEEDED / /- g/� TIME: /U TYPE OF INSPECTION: ��_ `U �� `�' aq4 0 !- /U- �f' ( SANITARY/LATERAL (PERMIT NO. 2 ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( } OTHER INSPECTION REPORT DATE: /CCJ TIME: ," o INSP: CONTRACTOR:— . ` WEATHER: 6Z4 .30 s WORK IN PROGRESS: la,4 lo3 ff ZL� AREA OF CONCERN: SPECIAL INSTRUCTIONS: