HomeMy WebLinkAboutDrain Layers Permit 45 Bissell Court TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT °N o 5703
JIB.0 19 7z-
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
AeAfer aa� at premises owned by
whose address is 27 �,'SSPI' and to
Lay House Drain, V., 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 6 t -
Show sketch of proposed work or furnish two (2) copies of separate drawings.
s� Pep rvvpq 5,* #ce
SPECIAL CONDITIONS
Desired Starting Date _ _ y 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 policy in the
name of the Town of South Windsor:
Engineer ng Dept . Date
Permit Fee Paid $ �� Check Number
Connection Charge Receipt No, G�/Zi Dated
y
Issued by
INSPECTION
Date work started 7 Z "-C�7/ ate completed
v
Sufficient notificat on received: �s No
Special Conditions
APPROVED: 1 Z) Z-12-�J Z
Inspector Date
' TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N° : .#�7
STREET
SUBDIVISION:.
Mi STATION : +
NORTH ARROW INVERT ELEV: x�0
TIE TIE
FT. FT
HOUSE LATERAL I LATERAL _ HOUSE
CONNECTION STUB STUB 1 CONNECTION
FT. e3 FT.
BUILDING INV. ELEV. INV.ELEV. I INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.)
17 (IF EXIST.)
TIE TIE
MH STATION : _Afi-+�
INVERT ELEV:
e, 0,vtt-� 4 '6
CONTRACTOR (PRINT) NAME OF CONTR*TOR'S SUPERVISOR(PRINT)
.r
STREETy:ADDR ESS� SIGNATURE DATE
TOWN STATE ZIP INSPECTE BY TOWN DATE
_Al�6(A
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER