HomeMy WebLinkAboutDrain Layers Permit 32 Bissell Court TOWN- OF
SOUTH WIN DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
at. Cam' ' �i 19%/
Pursuant to written application, permission is hereb gra to to the icens d Drain Layer named herein to perform the work. indicated below at
at premises owned b �` ��
y �� ��'� /vi�j nlAh1i /�To �`h+J� ��sr /�' /it,1C' whose address is
House Drain and to
Lay , Repair House Drain, Lay Main, Other
for
occupancy or use, with �; y,JF,
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (Vj/�' INDUSTRIAL
WASTES ( )s OR ( )
Connection will be made with
Show sketch of proposed work or furnish two (22) copies of separate drawings.
1�
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
:37
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
License ra n 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:
E gineering Department Date
Connection Charge Paid j� Permit Fee: Paid
�L Check Number (C'
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Insp ctor pat
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' :
STREET:
SUBDIVISION:
Mi STATION : +,.
NORTH ARROW INVERT ELEV: Z
TIE TIE
FT. FT
HOUSE LATERAL LATERAL _ _ HOUSE
CONNECTION STUB STUB CONNECTION
--�`'-�`--FT 71 3� 7 FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(FF EXIST.)
(IF EXIST.)
�zz
TIE TIE
WH STATION :
INVERTELEV:� z�0�
� !�! oA'S
CONTRACTOR (PRINT) NAME OF CONTRAC RCS SUPERVISOR(PRINT)
Re�llose, Aywje��
STREET ADDRESS SIG ATURE DATE
T WN u STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER