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HomeMy WebLinkAboutDrain Layers Permit 024 Carriage Drive (2) .�r�"e�cYi'..,,; aeym4a.rn•;�,. . -..n�-��'$�-,�',AN"#'.^''I!9Ns�!'jf9A:e �4S�'7'""� �'�,,":�?'f*�.',�R'gC�?Ts'-"I�RF�" .. :3: .., .. . . TOWN OF SOUTH WI N DSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT p' 199j Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform the /work indicated below at ) ¢ C q/Z/l/'y 6 g- 07Z at premises owned by � uf��clE whose address is �¢ C41z1yAG� p,,e S, w 1,U.6S J7l_ and to Lay House Drain, >< Repair House Drain, Lay Main, Other , for ,$/NGC F F,q occupancy or use, with Family Units, with acres. Type of Sewage to be connected under this permit: SANITARY SEWAGE K), INDUSTRIAL WASTES ( ), OR ( ) Connection will be made with �dcr Show sketch of proposed work or furnish two (2) copies of separate drawings. �a SPECIAL CONDITIONS Desired Starting Date 3 / - / Estimated Time for Completion /_ Permit to be issued to 70711 1XU14 L A61E-17: - ' r//�S S�P77 C SCFP V/C c the holder of Drain Layer's License No. ,�v�7�;z , . 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. Applic nt has re eived Town Permit No. and/or CHD Permit No. Signed Licensed Drain Layer The above named brain 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 $ 2- z Check Number c.,�-f' Issued by Tax Office INSPECTION Date work started Date completed Sufficient notification received: Yes No Special Conditions APPROVED: Inspector Date TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS OR LOT N° : STREET: SUBDIVISION: ,..0+ 11A-( STATION : + NORTH ARROW INVERT ELEV: n a©(yr TIE \/1 TIE FT 4or �� FT.HOUSE _____ LATERAL HOUSE, CONNECTION STUB CONNECTION FT. /a FT BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELE BUILDING (IF EXIST.) (IF EXIST.) _sJ� TIE TIE fM STATION : t INVERT ELEV: Sk I PS &E-10-77C, u IC4-=r CONTRACTOR (PRINT) NA RACT 'S S V OR(PRI T) a7 0I u.DDL/&9Wk- TED J If q/ STREET ADDRESS GN RE DA E- duo-rNGroA cr oG®.�_� TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER _ WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER