HomeMy WebLinkAboutDrain Layers Permit 359 Benedict Drive TOWN OF SOUTH WINDSOR
95 + � Ll
DEPARTMENT OF PUBLIC WORKS
BUREAU :OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NOW, r 6258
Pursuant to written application, permission is hereby granted to the
Licensed Drain aygr named herein to perform the work indicated elow at
-TJ1en4,c. - �C`, at premises owned by c.1c„ caw rtil L
whose address is ; AjaC', and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units., with acres .
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with
E Show sketch of 2xoposed work or furnish two (2;) copi4•,s of separate drawings .
OSHA REQU R ENTS MUST BE FOLLOWED
SPECIA CONDITI NS
Desire Starti Date - 57. Estimated Time for Completion
Permit to be issued to co
the h`older ,of Drain Layer' s License No. O . . 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 N and/or'
CHD Permit No .
Signed t 4�/Lad
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and . has filed a satisfactory bon and insurance policy the
name of the Town of South Windsor: \\�
�a� & 4
Engineering Dept . Date
Permit Fee Paid $ 95—CX3 Check Number ;4&'(G070 cy/mb191)
Connection .Charge Receipt No. D ed
Issued by Er . .
INSPECTION :
Date work started 1 _ Date completed _ ¢-J.3 9
Sufficient notificatlon recelved ., es No
Special Conditions
APPROVED: $
n pector, Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: Z- 3s' TIME:
BY: �'� a-,,� (�� � , FOR LOCATION: S gEi✓E !�I CT��
DAY INSPEC. NEEDED 4.- 13-2 5 TIME: 00
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. $'g ) ( } FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: J f,'dd INSP: &a661i4
CONTRACTOR: &,, WEATHER:
WORK IN PROGRESS: . �,
It 9-
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: