HomeMy WebLinkAboutDrain Layers Permit 11 Bridle Wood Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 6109
19
Pursuant to written application, permission is hereby granted to the
Li/tensed Drain L er named herein to perform the work ind�if at d b 1pw
L .. - Z e we* at pr raises owned by _1/LCc. d 17A-
whose address is , and to
Lay House Drain, __��Repaif House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
f Type of Sewage to be :connected under this permit : - SANITARY SEWAGE u
i INDUSTRIAL WASTES ( ) , OR
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit -to be issued :to
the holder of Drain Layer's License No.^ ?.trQillZ_.• Permit will expire thirty
(30) days after date of issuance. The undersigned Drain Layer hereby3agrees
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 _
Licensed Drain Layer
The above named Drain Layer has a valid license issued ,by the State of
Connecticut and has filed a satisfactory b nd and insurance policy in the
name of the Town of South Windsor:
4�/�-
E giniAfting Dept. Date
Permit Fee Paid $ ZS U Check Number 3B4k
Connection Charge Receipt No. 4 � Dated
Issued by
INSPECTION
Date work started -?v !k Date completed /V -zrv%Qi/-i'
Sufficient notific1- off'n rece ve : es No
Special Conditions
APPROVED:,..
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REOUEST
DATE OF REQUEST: l TIME: 3
BY: N - ��2 FOR LOCATION: GU 7— Zl
DAY INSPEC . NEEDED 4'1ao Mz1- TIME: C / t
TYPE OF INSPECTION:
( ✓) SANITARY/LATERAL (PERMIT NO. !� '7 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE:, L{- TIME: la hl� INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: