HomeMy WebLinkAboutDrain Layers Permit 40 Brian Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5941
Vk 19
Pursuant to written application, permission is hereby granted to the
Licensed Drain La er named herein to perform the work indicated belo at
O �. at premises owned by E S
whose 'address' is p and to
Lay House Drain >V R pair House Drain, Lay Main, Other
for {yo _,,I occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this perm�it : SANITARY SEWAGE ( ,
INDUSTRIAL WASTES ( ) , OR
Connection will be made with
Show ketch of proposed work or furnis o (2) copies of separate drawings.
OSHA REQUIREM TS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date �ZQ 9T Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. -:)os;,/ 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 —jz�,
Licensed Drain Layer
The above named Drain Layer has a vali 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:
n in ing Dept. Date
Permit Fee Paid $ �,5 ,00 Check umber
Connection Charge Receipt No. _jq LO-1 Dated
Issued byLZ2Z2
INSPECTION
Date work started 3 Date completed 4,z zo
Sufficient notification- rece ve es No
Special Conditions
001,
APPROVED•
Inspec or Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' :
STREET: 6p,tin (�
SUBDIVISION:
(D T_
NH STATION : +
NORTH ARROW INVERT ELEV:
TIE TIE
-FT F T.
HOUSE�\ ------LATERAL LATERAL HOUSE_______
CONNECTION e / STUB STUB FT. CONNECTION
-FT.
BUILDING INV. ELEV.. INV.ELE U. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) / •�
(IF EXIST.)
Jar/_rig TIE TIE
loaf
*i STATION :, t
INVERT ELEV:
1 � N
no W-c-,
CONTRACTOR (PRINT) NAME.OF CONTRACT RIS SUPERVISOR(PRINT)
STREET ADDR SS I NATURE DATE
�r
Sor C l o�7 V
i5OWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE- TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER