HomeMy WebLinkAboutDrain Layers Permit 104 Benedict Drive TOWN OF SOUTH WIN'DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �9
19 V
Pursuant to: written application, permission is hereby rante to the
Licensed;�rain sayerLna ed. herein to perform the work indicated below �t
--_y 0 45rr�.)<<'�:Ir .i' -at premises owned by AA
whose address' is and, to-
! ' Lay House.,"Drain, 7 . -"epair House Drain, Lay Main, Other ,
for j �/ /�� � occupancy or use, with 1
Family Units, with 'TT acres.
Type of Sewage t�onnected 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 REQUIREME,N-TS MUST BE FOLLOWED
SPECIAL gONDITIONS
Desired Starting 'Date Estimated Time or Completion
Permit to be issued to �-
the holder of Drain Layer' s License No. -cc�_. 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. VOL ') Jj .
Signed
cen e2��the
ayer
The above named Drain Layer has a valid license i 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 $ z,�j �if/f'G Check Number
..Connection Charge Receipt .No. Dated
Issued by � s� /v��h'r'
INSPECTION :`: f f
Date work started 7- l L Date completed / .
Sufficient notification rec ivea : Yes Nio
Special Conditions
APPROVED:
Inspector Date
ti l
r
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
7-
DATE OF REQUEST: TIME: 2,
BY: /KLf FOR LOCATION: /o y i3G�L%��Gl
DAY INSPEC. NEEDED '' Lam ` TIME:
TYPE OF INSPECTION:
( K ) SANITARY/LATERAL (PERMIT NO. / ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: ` INSP:
o,d
CONTRACTOR: A WEATHER:
WORK IN PROGRESS: J-7.1o14
•
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: