HomeMy WebLinkAboutDrain Layers Permit 337 Benedict Drive Is
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC V RKS
BUREAU OF POLLUTION CQ fiROL
5902
DRAIN LAYER S PERMIT;•
Pursuant to. written application, ,permissio:n is hereby granted to the
Licensed DranppLayer named herein to perform the work indicate;
'tel w at
3 PUi► CL at premises owned by
whose address is, and. to
Lay Hous D,.,ra . n, Repair House Drain, Lay,..Main, Other
for ��Ce � occupancy.or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ed) ,
INDUSTRIAL WASTES ( ) 0R ( ).
Connection will be made with
Show sketch of proposed work or, furnish two copies of separate drawings.
SPECIAL CONDITIONSC��SN 2<? Uje6W&7c1S
Desired Starting Date Estimated Time ;for. Completi
Permit to be issued to
the holder of Drain Layer's L fcerise" No Permit will expire, th rt.y:
(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 s; d."$
thereof. Applicant has received Town Permit No. and/off
CHD Permit Nor.
Signed
Licens d ain 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
rig neering Dept. . Date
Permit Fee Paid $ ' C��. �� Chec umberz7�
Connection Charge Receipt No. Dated a-5'"� J'
Is.s.ued by
INSPECTION
Date :work started - /6 - Date ,completed 2 9 .3
Sufficient notificatTon received; _ y es No
Special Conditions
_AP V
Inspector Date
TOWN OF SOUTH WINDSOR
.SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: _ 10
BUILDING ADDRESS OR LOT N' : �na
STREET: w^_pLI ( 1 (4
SUBDIVISION:
NH STATION : +
NORTH ARROW INVERT ELEV:
y TIE TIE
_FT -FT.
��- HOUSE LATERAL LATERAL HOUSE
rr ONNECTION STUB STUB
j ` CONNECTION
( 1 FT. eta FT.
S BUILDING INV. ELEV. / INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
1 (IF EXIST.) / (IFEXIST.)
( 1 uy p
TIE TIE
`S! l
CI IVY,4-1 1 l '
NH STATION : +
INVERTELEV:
CONTRACTOR (PRINT) NAME OF CONTRAC ORS SUPERVISOR(PRINT)
ALL
STREET ADDRESS SIGNATURE DAT
C:_v
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER