HomeMy WebLinkAboutDrain Layers Permit - void 11 Bitterswee ,i.7.//
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO 5691
nre I , 1991
Pursuant t written application, permission is hereby granted to the Licensed Drain Layer
named herein to. p rform the work indicated below at 1 at premises owned grrx►m (� ��er r �1 ► Tr Si sue'-r 1-A /PFantRr )
whose address is
La House Drain and to
3' , Repair House Drain, Lay Main, Other for A Family Units, with I acres. occupancy or use, with
Type of Sewage to be co nected under this permit: SANITARY SEWAGE (4, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
` A" - r' rQ — 11
Show sketch of proposed work or fu ish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimat Time for Completion
Permit to be issued to IYIAun t�an�, br
the holder of Drain Layer's License No R1 Z Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer hereb agrees to all the terms and
conditions set forth in the permit and the reverse side ther of. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed p
Lic se d Drain Layer
The above named Drain Layer has a valid license issued by the St to of Connecticut and
has filed a satisfactory bond and insurance policy in the name of the wn of South Windsor:
Engineering Department Date
Connection Charge Paid Permit Fee: Paid $ j Ua
Check Numbers
Tax Office Issued by
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' : 1t
STREET: NITS m LANE
SUBDIVISION: Eo
Mi STATION : L/ -}-
NORTH ARROW INVERT ELEV: 136.q(
TIE "� TIE
W
FT, r FT.
HOUSE 53.E
____ LATERAL LATERAL _______ HOUSE
CONNECTION STUB STUB CONNECTION
FT. �?J .y�
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.)
(IF EXIST.)
Rbnt4b tNS.CM%
132:77 CP(�cPosEo> TIE TIE
S
►� ' Mi STATION : ` � 3 + 30
Gb 2.q 9-pt. IZt?,O LT,
INVERT ELEV:
IN U.cmr-z Z5'.o i
&lLpE2 CorJsr, RN�e 17o14. ,
w�R)C�LFNrt KEEP � Ro��F� 4�,413u Okrr�n 6kom 601i'0�5 6eo HFtiJIJ�
CONTRACTOR (PRINT) NAME O CONTRACTOR'S SUPERVISOR (PRINT)
STREET.ADDRESS S DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
( `Zz3 ) ( 2$-7323 $ ►-2561
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER