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HomeMy WebLinkAboutDrain Layers Permit 30 Bissell Court TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT `'; Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below at r. at premises owned by whose address is andto - Lay House Drain, w 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 Show sketch of proposed work or furnish two (2) copies of separate drawings. SPECIAL CONDITIONS Desired Starting Date j7- f7 Estimated Time for Completion -j Permit to be issued to i/),;r the holder of Drain Layer's License No. 4; j j 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 cly` L eensed gain 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 4, name of a Town of South Win sor: E inee i epartment Date Connection Paid Char a �/�` J g f er t Fee: Paid $ �2: ,c�c, eckl Number Issued by Tax Office INSPECTION Date work started ©' �G r / Date completed Sufficient notification received: 1/ Yes No Special Conditions APPROVED: Inspector Date 1 TOWN OF SOUTH WINDJOR SANITARY SEWER LATERAL FIELD . LOCATION DATE OF CONSTRUCTION: N BUILDING ADDRESS OR LOT N' : STREET: r SSe�� e oUp- SUBDIVISION: Mi STATION : + NORTH ARROW INVERT ELEV: 12/9q,Q,� TIE TIE FT. FT HOUSE LATERAL LATERAL _ HOUSE CONNECTION STUB STUB CONNECTION A;32 FT 2' BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING (If EXIST.) (IF EXIST.) TIE TIE Mi STATION : f INVERT ELEV: CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT) A 4, Jk1,fzzL STREET.ADDRESS SIGNATURE DATE rfon t �a TOWN Cj STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER