HomeMy WebLinkAboutDrain Layers Permit 17 Calla Lily Lane _ TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL'
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DRAIN o 5845- LAYER'S PERMIT �"
19 9 Z
Pursuant to written application, permission is hereby granted to the
Licen ed Drain Layer named -herein t.o perform the work indic ted below at'
LO- e e�a�cGe. at premises owned by ��
whose ad r.ess is h/ and to
4 Lay House Drain, Re air ' ouse' Drain, Lay Main, Other ,
for occupancy or use, with
Family Unit , with acres
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , 'OR ( )
Connection will be made with
i
-Show sketch of p"roposed .work or furnish two . (2) copies of separate drawings.
SPECIAL CONDITIONS /7E' Lw4.0
Desired Starting Date --t Estimated Time for Completion Z
Permit to be issued to �l K
the holder of Drain Layer's License No. ��._0 Permit will exp"ire 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. P:ermit No . and/or ;
CHD Permit No.
n e �
Licensed 'Drain ayes
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:
%
En i eer. Dept. Date;
Permit Fee Paid $ ° -.�y Check um .er
Connection Charge Receipt. No. _ 4z,/7 . Dated
Issued by
INSPECTION
Date work started Date completed
Sufficient notification rece ve : es No
Special Conditions
APPROV
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: "3 -1-7'-9 7
BUILDING ADDRESS OR LOT N° : I�
STREET: L4LL-A LILY LA.
SUBDIVISION: P�k1cH�Q{ZtX�1C�
IMF STATION : +
NORTH ARROW INVERT ELEV: ( •��
TIE TIE
FT. FT.
HOUSE ff _ __ LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. ICI' FT.
BUILDING INV. ELEV. I�j�i oBV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) , �1 ) � (IF EXIST.)
L��
S�.5
TIE TIE
ho 5� (rA4+ l
NH STATION , t
INVERT ELEV: P 0' 10
WA W i L-Li h n5 5o0 g(, HP,IJgtk - GitoM b L0125.
CONTRACTOR (PRINT) NAM F CONTR SUPERVISOR(PRINT)
`3� IMav�NTRI�I i��
STREET.ADDRESS SIGNATURE DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
( ?-03 ) &&�- 9 3'?&
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER