HomeMy WebLinkAboutDrain Layers Permit 21 Cala Lily Lane A' TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITO 5739
19 2
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to)perform the work indicated below at
�� # Z Ci z q L I M� JPST4�at premises owned by L3�2oe 1 ,
whose address is 00 �S ow u J;ze'ff ��r��c and to
Lay House Drain, X 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 j
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date zzza y 2 Estimated Time f r Completion
Permit to be issued to
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.
S ed
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory 1:2
rance policy in the
name of the Town of South Windsor:
4 P�
E g neeri Dept. Date
Permit Fee Paid $ P 00 5 Check Vmber C1 E-76e`�
Connection Charge Receipt No. ` [5. b ated cl2..
Issued by
INSPECTION
Date work started 9 Date completed S��Z
Sufficient notification iece v3 ea : Yes No
Special Conditions
APPRQy.E
Inspector Date
A
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT Ng : f
STREET: CA-LLA t4l_� Lk ,
SUBDIVISION: pg-p-c-H(coa
NH STATION : + 6,
NORTH ARROW INVERT ELEV: 1 11,14
[[I
TIE Q) TIE
-FT F T.
HOUSE LATERAL LATERAL _ HOUSE
CONNECTION STUB STUB CONNECTION
-FT �Z. FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(I EXIST.) (IF EXIST.)
TIE TIE
10
bH STATION : L� + 55 �►nli��)
INVERT ELEV: O b
CONTRACTOR (PRINT) NAME 0 CONTRACTOR'S SUPERVISOR(PRINT)
35n pl(.z)"NT*q '7 FA��
STREET ADDRESS SIGNATURE DATE
Nzw A.Too )CT. 0611
TOWN STATE ZIP INSPECTED BY TOWN DATE
( 2 a'5) 3.7(o
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER