HomeMy WebLinkAboutDrain Layers Permit 011 Cambridge Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT t 9 01
19 �/
Pursuant to written application, permission is here y ranted to t e Lice sed Drain Layer
named herein to perform the work ind'cated below at �o / � �. �� �� -#11
at premi 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 INDUSTRIAL /
WASTES
OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS ,��/r� �
Desired Starting Date Estimated Time for Completion Z 6
Permit to be issued to
the holder of Drain Layer's Lase No. Permit will expire thirty (30) days
Y
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.
Signed
Licensed 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 Department Date
Connection Charge Paid Permit Fee: Paid'
l _' -�� Check Number
Issued by �!9?3 //--?..�-91
Tax Office '
INSPECTION
Date work started Date completed �� ;9
Sufficient notification received: �_ Yes No
Special Conditions
APPROVED: r •-2 3i
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N /0-/- 44
...�
i
STREET: C41 6i'i i U
0 SUBDIVISION: r s nl -
NH STATION : j7 + y
NORTH ARROW INVERT ELEV:
TIE TIE
17
FT FT.
HOUSE LATERAL LATERAL L. HOUSE
CONNECTION STUB STUB // CONNECTION
FT. �b <Gr• '?X6/FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) F (IFEXIST.)
TIE TIE
Mi STATION :-/--/ +Q0
INVERT ELEV:
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
STREET ADDRESS SIGNATURE DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER