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HomeMy WebLinkAboutDrain Layers Permit 25 Cala Lilly Lane 1"I TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL" DRAIN LAYER'S PERMIT " NO 5743 Pursuant to written application, permission is hereby granted to the Licensed DranL�yer nam d herein to. rform the work indicated below at G" �J LILc //c, �PEI'1� 8 mises owned by C�`�,�, Gy/ whose address is and. to Lay House Drain, _Repair Hous.e Drain, Lay Main, Other for occupancy or use, with Family Units , with acres. -� i 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. 4 f SPECIAL CONDITIONS Desired Starting Date /o y Z Estimated Time for Completion L Permit to be issued to so/i the holder of Drain Layer's License No. 7U '-)5 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 Drain Layer The above named Drain Layer has a valid license issued by the State of Connecticut and has filed a satisfactory bond andinsurance policy in the name of the Town of South Windsor : n ine g Dept. Date Permit Fee Paid $ Chec umber Cc �C6�( Connection Charge Receipt No. ted 2 Issued by INSPECTION Date work started - gyp- to completed /V'-9.� Sufficient notification rece ve es No Special Conditions APP' � )&specOorw Date TOWN OF SOUTH WINDSOR w��P4 ,,,Hiv'ITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS OR LOT N' : STREET: CAL-(-R LILY LA SUBDIVISION: pg7AC�b9c0KE Mi STATION : CVhi-I -412) NORTH ARROW INVERTELEV: I `Sl.iy 37 TIE TIE JF FT -FT, HOUSE LATERAL LATERAL _ HOUSE CONNECTION STUB STUB CONNECTION FT. BSI .`l(® FT. BUILDING INV. ELEV. INV.ELEV. INVU. . ELEV. INV. ELEV. BUILDING (If EXIST.) (IF EXIST.) A TIE TIE VMq STATION :�t 5S �►'�� �/ INVERTELEV: 15G�'iV tA X irk ILL-!A✓Ag-, 45095 ev � qRo-m cxk WW1 Owk 5 CONTRACTOR (PRINT) NAME F CONTRAC 0 SUPERVISOR(PRINT) STREET ADDRESS SIGNATURfE DATE pqw lA W64, Cr. ©61lt TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER