HomeMy WebLinkAboutDrain Layers Permit 7 Bissell Court T TOWN OF SOUTH WINDS
OR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
( DRAIN LAYER'S PERMIT #t
tiJ��v 19
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at ;
at premises owned by !: :i th{,p,; f 1, whose address is
Lay House Drain, y; Repair House Drain, La Main and to
for �— y , Other ,
occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE O`), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work �oj�_fgrrnish two (2) copies of separate drawings.
y
SPECIAL CONDITIONS
Desired Starting Date ' - Estimated Time for Completion -
Permit to be issued to
the holder of Drain Layer's License No. 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 policylin tpe name of he Town of South Windsor:
E inee4 apartment Date
Connection Charge Paid * /--/C',S 9 Permit Fee: Paid $ ;x5 c`. C�
�C, eck'l Number
Issued by
Tax Office
INSPECTION
Date work started �d — Zlf—°1' Date completed /0 — —��
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' : kd- Z2
STREET: 6i,SSP_ /` o
SUBDIVISION: ZeL,
4.
0
NH STATION : Ae-+ .
NORTH ARROW INVERT ELEV: a7.15
U.
TIE Itk
TIE
r
_FT F T.
HOUSE LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT.
BUILDING INV. ELEV. INV.ELEV. U. INV. ELEV. INV. ELEV. BUILDING
(If EXIST.)
(IF EXIST.)
i
TIE TIE
M-1 STATION Aµ +t3
INVERT ELEV: fz&V
E ) Opt co c 0 Al +tc, /C 6 01-
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
to mpjfrn�)f, -z--f 4
STREET ADDRESS SI NATURE DATE
ID�f MtrnQ, h✓� (n (o( ,�
TOWN u STATE ZIP INSPECTED BY TOWN DATE
-( -/-o2)) VM -(0.0
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 1-2,1 &
BUILDING ADDRESS OR LOT Ne - /,4 0ZZ
STREET: - Ct,A,A``h4 wo.
SUBDIVISION:
NH STATION :
NORTH ARROW INVERT 0
ELEV:
M �
TIE TIE
-FT
FT.
HOUSE LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. �
INV. ELEV. INV.ELEV. H FT.
BUILDING U. I V. ELEV. INV. ELEV.
(IF EXIST.) BUILDING
O F EXIST.)
1/ 17
TIE TIE
AM STATION : #, f-f()L3dti
INVERT ELEV:
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
STREET ADDRESS SIGNATURE DATE
i
TOWN U STATE ZIP INSPECTED BY TOWN DATE
P03 ) (2(a-/0"
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER