HomeMy WebLinkAboutDrain Layers Permit 88 Bramblebrae W J
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N9 61 is
:✓ -i� 919
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated. below at +
re qen E at premises owned by - zz. MA/�t y
whose address is / .n and to
Lay House Drain, 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 separated"rawings.
OSHA RE0VTR&AENZZ_M_9=1BE FOLLOWED -
SPECIAL CONDITIONS
- Desired - Starting Date Estimated Time for Completion
Permit to be issued to (' _F—d
the h4� der of Drain Layer's License No. - - , q4:7 1. 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
there>of. Applicant has received Town Permit No. a d/-or
CHD Permit No
Signed
L ensed rain aye
The above named Drain Layer has- a valid. license is ed the tate of
Connecticut and has filed a satisfactory bond and insurance cy in: the
ame of the Town of South Windsor;
Engineering Dept , Date
Permit Fee Paid $ " , 5".00 Check Number '
:-ionnection Charge Receipt No. ,L�,L�1.(_ Dated
Issued by
IN'SPECThQN
Date wor, started rj'-. /'q_ 9 Date completed
Sufficient- notificatlon recelvea ; _ —Yes No
Special Conditions
APPROV
Inspector Date
3' a
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
{ DATE OF REQUEST.- G''� ���--`� TIME: l�
BY: FOR LOCATION:
DAY INSPEC. NEEDED r�/rr�� TIME: (
TYPE
OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: f TIME: 24006 INSP•
CONTRACTOR: WEATHER• SCJ
WORK IN PROGRESS:
r
n
- J
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: