HomeMy WebLinkAboutDrain Layers Permit 31 Birch Hill Road r
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 6053
19�
Pursuant to written application, permission is hereby granted to the
Licensed Drains ayer named herein to perform the work indicated belo aCN ' It
at premises owned by n s m R `
whose address is rn � w zn
Lay House Drain, ,Repair House Drain, Lay Main, Other and to
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
Show sketch of proposed work or furnish "two (2) copies of separate drawings.
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
.
Desired Starting--Date // _�? .,
�' -- Estimated Time for Completion >
Permit to be issued to �? ;n I,•- � �, `�: v �4 rv� 4 `ae �,
the hplder of Drain Layer's License No. ilA�'
p �(a %� 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. - `
Signed
Licensed Drain 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:
Engineering Dept. Date
Permit Fee Paid $ Check Number
Connection Charge Receipt No. t 3F. Dated
c? r
`"1
Issued . by
INSPECTION
Date work started O -
Sufficient notifica"r on re/ ive ; yes
completed
Special Conditions
APPROVED• �� �`
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: f�--Z�- '�J'' TIME:
BY: �j�t�•r� FOR LOCATION:��� 90,P4 r
DAY INSPEC. NEEDED 3o-:93 TIME: ZQ ° ?Io &I'l
TYPE OF INSPECTION:
( VI) SANITARY/LATERAL (PERMIT NO. � ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) { ) OTHER
INSPECTION REPORT
DATE: -- TIME: 10:0 6 -- Z r 0 INSP:
CONTRACTOR: L WEATHER: °�
WORK IN PROGRESS:
r '
c
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: