HomeMy WebLinkAboutDrain Layers Permit 19 Calla Lily Lane . ....� TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �( No 8
3.
^Tk w e 19 S L
Pursuant to- written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
`7_ C i<� Li at premises owned by 6acy,
whose address is 0 !..> ` and to
Lay House Drain, Repair House Drain, Lay Main, Other . ,
for fn occupancy or use, with
Family Units with acres .
Type of Sewage to be connected under this permit : SANITARY SEWAGE Q\I,
INDUSTRIAL WASTES ( ) , OR (.
Connection will be. made with {L�
Show sketch of proposed work or furnish two (2) copies of separate drawings.
�� ,UsYa �prcv
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. ;?Qt2yj 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 i g n e �I
SLicensed 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 policy in the
name of the Town of South Windsor
Engineering Dept. Date
Permit Fee Paid $ Uv Check Number, .-1 O
Connection Charge 'Receipt No. 1�//,�' Dated
Issu-ed by
INSPECTION
Date work started Date completed 'j�--/0-7R7
Sufficient notification rece ve : es -� No �-
Special Conditions
AP C -4 44
nspector Dane
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: �l'7-�2
BUILDING ADDRESS OR LOT N° : +�
STREET: C61-LA LILY LA,
SUBDIVISION: "8AwI<c
NH STATION . L +
NORTH ARROW INVERT ELEV: �� •�y
U.
)) I
�1 1
TIE 0 TIE
-FT -FT.
HOUSE LATERAL LATERAL _ HOUSE
CONNECTION 7 STU8 STUB CONNECTION
FT. A5701 FT.
BUILDING INV. ELEV, INV.EL V. U. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) QF EXIST,)
t
)o2
TIE b TIE
NH STATION :
INVERT ELEV: ��►•I
W •1 A .. LJ I LLI PI M S
CONTRACTOR (PRINT) NAME CONTRACTO ;S SUPERVISOR(PRINT)
3 ►'n0�t 1.1'�1�rhJ ��. .
STREET ADDRESS SIGNATURI DATE
CT 06 111
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER