HomeMy WebLinkAboutDrain Layers Permit 16 Carson Way TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6024
'Z�wo 4 13
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein t perform the work indicated below gat
�p l G7}rf [ �/ � mises owned by / 2a�?.�f . C:C�
whose address is 30 S0 tQ
Lay House Drain, RepaiV House Drain, Lay Main, Other ,
for _�' .Mi c.. occupancy or use, with S' le
x
Family Units, w th _acres.: -
j 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 separatedrawings.
OSHA REQUIREMENTS MYST BE FOL OWED
SPECIAL ,CONDITIONS_p ,. A 'G ,��h '•,�5c�l�o+�J
Desired Starting Date Estimated Time for Completion_
Permit to be issued to
the holder of Drain Layer's License No. jOQ,(�' aC) . 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. Applicant has received Town Permit No, and/or
CHD Permit No.
Signed Ztti = f-0,J
ice ed D in Layer
The above named Drain Layer has a valid lice a shy d by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
A UP Ila-11
Engineering Dept. Date
Permit Fee Paid $ Z--!�� Check Number /2--/ jf
Connection Charge Receipt No. 43'7 Dated fl�,�/Z/-?-�
Issued by
INSPECTION
Date work started O' Date completed
Sufficient notification receiveH': Yes No
Special Conditions
APPROVED: /� ✓/7
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
4-
DATE OF REQUEST: TIME:
BY: f/;Vv/ J�(�-� FOR LOCATION: "v '/ C�� ✓ '` '
DAY INSPEC. NEEDED "7 3 TIME:
TYPE OF INSPECTION: r
O SANITARY/LATERAL (PERMIT NO. J 'Ll ) O FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
r INSPECTION REPORT
DATE: /Q- 2 0 -- 9.3 TIME: f ko rf oQ 1t Z-rd O INSP:/,JAG
r CONTRACTOR: WEATHER:
WORK IN /PjROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: