HomeMy WebLinkAboutDrain Layers Permit 056 Cambridge Drive TOWN . OF SOUTH WINDSOR i
DEPARTMENT OF PUBLIC WORKS
' BUREAU OF POLLUTION CONTROL
56 CAMBRIDGE DRIVE DRAIN LAYER'S PERMIT 6276
19y
il�a Pursuant to written application, permission is hereby granted :to the
Licens Dra ,a Layer named herein to perform the. work indicated below t
at premises owned' by �.�•�
whose address is "...� and to
Lay House Drain, 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 (0ej
INDUSTRIAL WASTES ( ) , OR { )
Connection will be made with h
Show sketch of proposed work o�, f rnish two (2) copies of separate drawings .
OSHA REMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date ,. jn ,. Estimated Time for Comtor .1
pletion ",,,:'
P4rmYt #o be issued to vc.
th'e holder Drain Layer ' s License No .>;
�_ 7d�r P rmit will expire thirty
r ( 30) -oys a7ft.er date of issuance. The undersigned Drain Layer hereby agrees
i" 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 .
r
Signed �e,.
Lice seo rain 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 :
,a y
Engi Bering Dept . Date
Permit Fee Paid $ 0�5 y Check Number ' `f
Connection Charge Receipt No. 550 Dated
Issued by
INSPECTION _ -
bate work started _ (? < ate completed 3p.. 'S
Sufficient notification receive No
A— yNo
Special Conditions
APPROVED: 5--30-9
Inspector Date
SANITARY LATERAL._& EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF..REQUEST: rj/�( 9- TIME: 9,00 Orr\
BY: 7OR LOCATION: Cat C �f
fJ
x m• '`DAY INSPEC. NEEDED ���s . l,�c� TIME: ���.
TYPE- OF fNS.PECTION:
t ( SANI'TARY'f'LA-TERAL PERMIT: NO-. FOOTING- DRAIN,
t ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
NVSPECTION,RERORT:
DATE. '^ TIME: ► d 0 INSP: p
CONTRACTOR f WEATHER~. 6 5 ®4-
WORK IN P OGRESS:
l� d
ALL
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: