HomeMy WebLinkAboutDrain Layers Permit 20 Brookfield Street TOWN. OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6223
�QC ao 19 /
Pursuant to written application, permission is hereby granted to the
Licejised r&,14M
er naured herein to pperform the work indi ateA, b /.l� at
S�c t remises owned by J=�I /4t
whose address is 30 0941fl-1p '
and to
Lay Housg D a , epair House Drain, Lay Main, Other ,
for -C / ofJ�e occupancy or use, with /
Family U4fits ,. witW acres .
Type of Sewage to be 'connected under this permit : SANITARY SEWAGEj ,
INDUSTRIAL WASTES (' ) , OR ( )
Connection will be made with
Show sketch ofproposed work or furnish two (2) copiers of separate drawings .
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion Q
Permit t,o be issued to r o4� m
-el�1_1_
the holder of. Drain Layer ' s Licens No. Permit will expire t'hfrty
( 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
GHD Permit NO .
Signed
L tensed Drain Layer' . ,
The above named Drain Layer has a valid license issued by the State� of
Connecticut and . has filed a: satisfactory bond and .insurance.. p,plicy.` :- kh. the:
name of the Town of South Windsor:
E n g i Arering .Dept . Date
Permit Fee Paid $ .00 Check Number ��
Connection Charge Receipt N.Q /$ Dated 9
Issued by
INSPECTION
a�.
Date work started J 2 D Date completed .-�
Sufficient notification receivec : _ es No -
Special Conditions
APPROVED-,' /Z^Zce ,
Inspectors Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: — TIME:
BY: FOR LOCATION:
DAY INSPEC. NEEDED 7 Gc � TIME:
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. ZZ ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: t2- - 2 O - 4. TIME: INSP:
CONTRACTOR: WEATHER: O ®
WORK IN PROGRESS:
� O
Y
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: