HomeMy WebLinkAboutDrain Layers Permit 159 Brookfield Stree TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 6286
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_9 11 A) (a
19L)
Pursuant to written application, permission is hereby granted to the
Licensed Drain Laye named herein to perform the work indicated below , t
�� at premises owned by _
whose address is and to
Lay House Drai , Repair House Drain, Lay Main, Other ,
for occupancy or use,_ with
Family Un ts , with __acres .
Type ofSewage to be connected under this permit : SANITARY SEWAGE �fJ ,
INDUSTRIAL WASTES ( ) OR ( )
Connection will be made with SDR 34 - .�.
Show sketch of prop1sed work or furnish tw ies of separate rawings .
C/� YO
PPS
ENTS ST �E F LLO D
YI SPECIAL GONDITIONS
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(,.
Desired Starting Date K7 Estimate Time for Completion r3_ju
,Permit to be issued to s
the holder of Drain Layer ' s License No . O 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
Licens end_ Drain Layer
The above named Drain Layer has a va 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 :
( ' 2$Z7 �' ar to1It ngineezing Dept . Date
Permit Fee Paid $ 2 5,00 Check Number L� ' Z¢SZ
Connection 'Charge Receipt No. :4 S 43 Dated 6-/'
Issued by
INSPECTION
Date work started Date completed
Sufficient notification received : ----- es No
Special Conditions
APPROVED•
Inspec or Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
-.DATE OF REQUEST: TIME: 3 ` Z `J
BY: �1T/N r&go aj r FOR LOCATION: 59 .CS C�or�u F(�Lb /,
DAY INSPEC. NEEDED 6 C3 Qj 57 TIME: 9 D O d" / r r;7d /2,'yw 'rr'l
TYPE OF INSPECTION:-
( ) SANITARY`/'LATERAL-:(PERMIT- NO. Z 6 } ( :.. ) FOOTING-DRAIN:
( ) EXCAVATION (PERMIT NO. ) ( } OTHER
INSP-EGTION� REPORT.;-: ,
DATE: j - �/3_9 TIME: INSP:
. :CONTRACTOR
p� WEITHER:,
WORK IN ROGRESS: A ' buql-: ;e- I
r-
.% Zui
AREA OF CONCERN:
-SPECIAL INSTRUCTIONS:
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: f`� Jvh)
BUILDING ADDRESS OR LOT N° : C
STREET:
SUBDIVISION:
�� - ' l 'f
NH STATION : �+n, 7
77 NORTH ARROW INVERT ELEV: ✓1? '
TIE i^ TIE
-FT / -FT.
HOUSE �zo, f LATERALm LATERAL HOUSE
CONNECTION J TUB STUB CONNECTION
- FT. �' 5 loop FT.
BUILDING INV. ELEV. INV.ELEV INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) (IF EXIST.)
rc TIE ] TIE
L'c"Jel4o ryov
1 Lo AM STATION .l+
INVERTELEV:
CONTRACTOR (PRINT) NAME OF CONTRACT RCS SUPERVISOR(PRINT)
STREET ADDRESA
/ SfJNATU DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
C 2d3 ) �00 7S
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER