HomeMy WebLinkAboutDrain Layers Permit 41 Bissell Court G ,4� TOWN OF SOUTH
WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT5662
� �� , C��� � - �z -1 , 19--1L
Pursuant to written application, permission is hereby Sranted to the Licensed Drain Layer
named herein to perform the ork indicated below atf_
at premises owned by
whose address is
La House Drain and to
Lay
Repair House Drain, Lay Main, Other for ,
Family Units, with .acres. occupancy or use, with
Type of Sewage to be connected under this permit: SANITARY SEWAGE
WASTES OR, �' , ( ), INDUSTRIAL
( ) ( ) fJ �� 3 Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to ', ,
the holder of Drain Layer's License No. -Z 7 �T , 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-- AppliC t has r eived
Town Permit No. and/or CHD Permit No.
Signed
F
ensed rain,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 n he name the Town of South Windsor:
/ o j f6 bl
En ine Department / Date
Connection' 6ha:rge" Paid�(U j Pe m t Fee: Paid $
heW
$#:,/��3
Issued by
Tax Office '
INSPECTION
Date work started -1 7—0�( / Date completed
Sufficient notification received: tl Yes No
Special Conditions
APPROVED:
'Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N° :
STREET:
SUBDIVISION:
*i STATION :
NORTH ARROW INVERTELEV: J_3Z07
TIE TIE
TFT. FT
HOUSE LATERAL LATERAL _ _ HOUSE
CONNECTION STUB STUB CONNECTION
--1__FT. 0 l.� 65
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. FT
(IF EXIST.) BUILDING
11 (IF EXIST.)
M.
TIE boll
TIE
NH STATION : /r & cI
INVERTELEV: 28-O
P synnp, _&L IL'y-
CONTRACTOR (PRINT) n NAME OF CONTRACTORS SUPERVISOR(PRINT)
STREET.ADDRESS SIGNATURE DA E
—FM_m & r-i U
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE TOWN PINK — CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER