HomeMy WebLinkAboutDrain Layers Permit 270 Brookfield Stree TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 6096
fiD 19
Pursuant to written application, permission is hereby granted to the
Licens Dra� L yer amed .herein to perform the work indicated- below at
�o �SU at pre ises owned by e '
whose address is '
and to
Lay House Dra n, 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 S"I) O /AJ,Y 3
Show ketch of d work o� furnish 'two (2) copies of separate drawings-.
.4; , I 7 0
SPECIAL CONDITIONS_
OSH REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date Estimat Time for Completion
Permit to be issued to —1� -S �rl� (/�j`-�—✓
the holder of Drain Layer's License No. Q ,, 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
Licensed Dra n Layer
The above named Drain Layer has a vali license issued by the State of
Connecticut and has filed ,a satisfactory bLnd and insurance policy in the
name of the Town of South Windsor: /
E �in __Ong Dept . Date
Permit Fee Paid Check umbera�
Connection Charge Receipt No. /A91c, Dated 32—b- 9/94
Issued by Z(-i
INSPECTION _
Date work started 7 rJ / 4-- Date completed 7
Sufficient notification r ce ve : es No
Special Conditions
APPROVED•.
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: LA �,� � TIME:—- 9: R
BY: FOR LOCATION:
DAY INSPEC. NEEDED �6 �'1 TIME: g3e' �R
TYPE OF INSPECTION:
SANITARY/LATERAL (PERMIT NO. G0q rQ ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 4 - 7- TIME: J = O ® INSP:
CONTRACTOR: e WEATHER:
WORK IN PROGRESS: '
e
r
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: