HomeMy WebLinkAboutDrain Layers Permit 44 Bissell Court TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT i 4-No 5758
19-L L
Pursuant to written application,. permission is hereby granted to the
Li ensed Drain Layer named herein to perform the work indicated below at
i at premises owned by
who address is and to
Lay House Drain, _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 A) ,
INDUSTRIAL WASTES ( ") , OR ( )
Connection will be made with G
Show sketch of proposed work or furnish two (2) copies of separate drawings.
s � 146opoo VC 5
SPECIAL CONDITIONS
Desired Starting Date -,� Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer' s License No. -�7-7-7141 Permit will expire thirty
(30) days after date o.f 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:
Engi ee ing Dept. Date
Permit Fee Paid $ �j,QQ Check Num r
Connection Charge Receipt No. /��`<j j. Dated
Issued .by
INSPECTION -
Date work started ate completed S '—
Sufficient notification rece ve : Ceyes No
Special Conditions
APPROVED:
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: —��
BUILDING ADDRESS OR LOT N' : � pel���v�
STREET:
SUBDIVISION: GS Df
r
IVH STATION : +
NORTH ARROW INVERT ELEV:
TIE \ TIE
FT. FT
HOUSE LATERAL LATERAL _ HOUSE
/�_
CONNECTION / p _ Sy8 STUB CONNECTION
FT l 0 FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(If EXIST.) (IF EXIST.)
TIE TIE
W STATION : t�
INVERT ELEV: 20
All) �ml a tot
CONTRACTOR (PRINT) NAME-OF CONTRACTOR'S SUPERVISOR(PRINT)
STREET-ADDRESS SIGNATURE DATE
cw
TOWN V STATE ZIP INSPECTED BY TOWN DATE
) a 26
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW-CONSULTING ENGINEER/DEVELOPER