HomeMy WebLinkAboutDrain Layers Permit 163 Birch Hill Drive ..... .,. -. ..,�.., nr«.. .., �,."�+e�� -,�,t.;,.,, � ••• .. .r�.�, ,� "�'"rr.:x7". r.*', .,fir..-..,,�.�,.�.��
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITN2
19
-?S
Pursuant to written application, permission is hereby granted to the
Licensed Drain La er na ed herein to perform the work indicat,/�d� ��. below at
fur ,E A Q � at premises owned by � C ^ 1
whose address is 7%A^1 E and to
Lay House Drain, �- Repair House Drain, Lay Main, Other
f.or c 4- occupancy or use , with. —�
Family Unfits ,, with acres'.
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with ,6 7
Show sketch of proposed work or furnish two (2) copies of separate drawings .
le
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired .S.tarting Date Estimated Time for Completion
Permit to be issued to jy ,� ,✓{ 1Y1,.'C
the holder of Drain. Layer ' s License No. _ �� �G� 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. t.he permit and the reverse side
thereof . Applicant has received Town Permit No, and/or
CHD Permit- No . �j
Signed
is used Dr i r
The above named Drain Layer has a valid license issued by. a State of
Connecticut and has- filed a satisfactory and and insurance, policy in the
name of the Town of South Windsor:
gin a ng Dept . Date
Permit Fee Paid $ ,pU Chec umbel _!-L"7C0
Connection Charge Receipt No. Pated y
r
Issued byl/Z �J
INSPECTION
Date work started to completed _-��. _
Sufficient notification rerelved ; es No
Special Conditions
APPROVED: "
nspector Date
SANITARY LATERAL & EXCAVATION PERMIT
r•
INSPECTION REQUESTo�
DATE:OF REQUEST: �7/ /� TIME:
_BY: �l.�l.p I/er��-��y FOR LOCATION: 16:�'
DAY INSPE.0.;"NEEDED S /S f.�� TIME: 1/� PrV✓�
f >- TYPE OF INSPECTION:
SA (P T'::NO': Zi�`1 } ( .. ).
FOOTING: DRAIN_.
EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPEQTI N,.,REP0R->
. DATE: � _ l !`` ~9$ TIME: /p r p INSP: ��� �
`f CONTRACTOR= C /T WEATHER:;
-WORK IN PROGRESS: 1.l� (`Q� e� c�3� ld x o4 !_eic�11 eh 7�C�c,
Aff
16 _ ,95
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AREA OF CONCERN:
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.. SPECIAL INSTRUCTIONS: