HomeMy WebLinkAboutDrain Layers Permit - void 7 Bittersweet TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5692
191' l
Pursuant to-written-application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at ,�Y -7 SiTrer9w act LA l U „ c 4N g
at premises owne by R%3.t Je,;rc whose address is
and to
Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use, with
Family Units, wi h acres.
Type of Sewage to be nnected under this permit: SANITARY SEWAGE (41"' INDUSTRIAL
WASTES ( ), OR ( ) Connection will made with
Ai
Q 1 L Qv w La Or,a
Show sketch of proposed work or f ish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimate Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. �Permi will expire thirty (30) days
after date of issuance. The undersigned Drain.Layer hereby rees to all the terms and
conditions set forth in the permit and the reverse side thereo Appl:,,icant has received
Town Permit No. and/or CHD Permit No.
Signed
'L��6_�-� klj\,k
Licen;-n
Drain Layer
The above named Drain Layer has a valid license issued by the S of Connecticut and
has filed a satisfactory bond and insurance policy in the name of thwn of South Windsor:
Engineering Departm Date
Connection Charge Paid
g Permit Fee: Paid $ �Cs� �L Check Number
Issued by
Tax Office
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: -(I-q i
BUILDING ADDRESS OR LOT N' : �
STREET: l?, -Fr+g--se%" t^
SUBDIVISION:
AM STATION : t + 3o
NORTH ARROW INVERT ELEV: 110
a
TIE TIE
_FT F T.
2'7
HOUSE LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT izy.�Z FT.
BUILDING ENV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
ILL
(IF EXIST.) \
I (IF:EXIST.)
�ovSi�tG �D�nf,a L I Z.� _o
1NJ. t24.7S1P�'oPeh�� TIE �= - TIE
1
C
o NH STATION : + '�u
P` x 66) �N '� INVERTELEV. 1) .
QCutP�Curt S T• Akk kXCAvA-n 9r/ a -
GL'ENja Rao
CONTRACTOR (PRINT) NAME OF CONTRACT RCS SUPERVISOR (PRINT)
G-! srur rnq rtc ff.► ' ! ��o cat ►N Ro. - o -z .
� ( s �r
STREET.ADDRESS SIGN WTIJ Rk DATE
S.WIN05R , C-T. 6uz9AH , Cl--
TOWN STATE ZIP INSPECTED BY TOWN DATE
( Z°3 ) 52-9-73z3 1851-2SOI
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER