HomeMy WebLinkAboutDrain Layers Permit 27 Calla Lilly Lane N
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ' No 5748
19 9 .Z
Pursuant to written application, permission is hereby granted to the
icensed' Drain La er named herein to perform the work indicated below at
premises owned by 06"1, &za 2
whose address is GL,/ D�� �,, and to
Lay House Drain, _ Repair House Drain., Lay Main, Other ,
for occupancy or use, with j
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ( ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date / 2 EstimAted Time for Completion o S Z
Permit to be issued to , �-�. .,v-C
the. holder of Drain Layer's License No. 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.
"--e d Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactor b nd and insurance policy in the
name of the Town of South Windsor:
-Oa E gin a ng Dept. Date
Permit Fee Paid $ Chec Number 0 Z '7 62 3
Connection Charge Receipt No. 4-1 ¢1 ated
Issued by
INSPECTION
Date work started •�qL Q '2o-97i
Sufficient notificatio nreceiv a : Bate completed
'--Yes No
Special Conditions
APPROVED: ?.v Z
I s ector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' : 2
STREET: C#tLL-A LIL_ Lh
SUBDIVISION: bpDDI(-
f I STATION :
NORTH ARROW INVERTELEV:
r
00
TIE TIE
-FT -FT
HOUSE ___ LATERAL LATERAL HOUSE
TI CONNECON STUB STUB CONNECTION
FT. 15 I.A FT.
BUILDING INV. ELEV. INV.ELEV. INVU. . ELEV. INV. ELEV. BUILDING
(IF EXIST.) It (IF EXIST.)
Aft
TIE ( TIE
f*i STATION :
INVERT ELEV: G. i G
W.1 - W IL.L IAM5 SOO RE(o �hrj 6, --166� 6LO25
CONTRACTOR (PRINT) NAME CONTRAC 0 �S SUPERVISOR(PRINT)
°Ir Y'�wrl Tot I4 �.
STREET ADDRESS SIGNA DATE
�I-1<s Io(-Orb)4 ,c-r ®G I I I
TOWN STATE ZIP INSPECTED BY TOWN DATE
( 203) ( &(o-gl76
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER