HomeMy WebLinkAboutDrain Layers Permit 14 Bissell Court b`' TOWN OF SOUTH WINDSOR
'(1 DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL 5773
DRAIN LAYER'S PERMIT 4' Q
19
Pursuant to written application, .permission is hereby granted to the
Licensed D 1.11 Layer named herein to perform the work in,�dic teal below at
t premises owned by I� ao(" d 5(-�kj
whose address is 71 p and to
Lay House Drain, Repai House Dra n, Lay Main, Other
for occupancy or use, with
Family Units, with acres.
.Type of Sewage to be connected under this permit : SANITARY SEWAGE O ,
INDUSTRIAL WASTES `( ) , OR { )
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
sly& lce
SPECIAL CONDITIONS
Desired Starting bate h7 Z;3- Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. Q>77gl 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 �rmit. and the reverse side
thereof . Applicant has received Town Permit No. and/
CHD Permit No. ,_/ —�
Signed"
Licensed Draif 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:
Enginee ing Dept• Date
Permit Fee Paid $ c�5�0 Check Number
Connection Charge Receipt No.. L//6� Dated , C�
Issued by
INSPECTION
Date work started Date completed
Sufficient notification receives :—'—'d es No
Special Conditions
APPROVED:
Insp-ector Date
i
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N° :
STREET: 5jc � m
SUBDIVISION:
�f
NH STATION :
NORTH ARROW INVERT ELEV:
T - 5_
6, TIE TIE
T FT
-FT,
HOUSE _- __ LATERAL LATERAL IF HOUSE
CONNECTION =
i
STUB STUB CONNECTION
FT U
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. FT.
(IF EXIST.) BUILDING
(IF EXIST.)
TitTIE
to
AM STATION :r` L#_l_
INVERTELEV:
&e5 nA k),160LY,
CONTRACTOR (PRINT)
N E,OF CONTRAtJOR'S SUPERVISOR(PRINT)
I �
STREET ADDRESS SIG ATURE GATE
Ilk 0 3-2, -,
T WN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE -TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER