HomeMy WebLinkAboutDrain Layers Permit 144 Cambridge Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT O
19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
e dy-, A1,44 at premises owned by
whose address is Aft a to
Lay House Drain, Repair Hou a Drain, Lay Main, Other ,
for occupancy or use, with 1
Family Units ,Aith acres.
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.
OSHA REQUIREMENTS MUST BE F019LOWED
SPECIAL CONDITIONS j2 15 b tV'
Desired Starting Date Estimated Time for Completion
Permit to be issued to ff-
the holder of Drain Layer ' s License No. 'Z4)$4''30 Permit will expire thirty
(30) days after date of issuance. The undersigned Drain Layer hereby agrees
r<.
to all the terms and conditions set forth in the permit and the reverse side
x, thereof . Applicant has received Town Permit No. and/or
t CHD Permit No.
Signed !'
ice Yd
n Layer
The above named Drain Layer has a valiAl icens:!�i
ssby the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
En ineerin gDe t.
Date
P..ef t-'IF e° aidf a, .fly Check Number C
Connection Charge Receipt No. /Wj Dated 99c
Issued by
INSPECTION
Date work started Date completed — Z—
Sufficient notification received: es No
Special Conditions
APPROVED: ,Z /7
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:
BY: FOR LOCATION: A-e%/1/`
DAY INSPEC. NEEDED - -et TIME:
TYPE OF INSPECTION:
SANITARY/LATERAL (PERMIT NO. G9/3 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: Pi 7-7 INSP:
CONTRACTOR: WEATHER: C° GJ�rG
WORK IN PROGRESS:
2,12
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: