HomeMy WebLinkAboutDrain Layers Permit 61 Carson Way TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6025
,
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated belo at
to 9 C C7 . D t`1 at Promises, qwned by
whose address is qh So, o✓
Lay House Dr, in, Repair use Drain, Lay .Main, Othe a tq
for i occupancy or use, with
`&&ay Units with acres. Coll
Type of Sewage to be connected under this permit: SANITARY
INT �RZAL-WASTES ( )', OR ( ) P RY SEWAGE
ution will be made with 3 r
Sh�w sketch of proposes work or furnish two (2) copies of separate drawings.
OSHA REQUIREM TS MUST FOLLOWA
SPECIAL CONDITIONS tb
Desired Starting Date /O—)V Estimated Time for. Completion
Permit to be issued to "��� 1�
the holder of Drain Layer's License No. Z;,eM 3C) 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 r
Licen d Drai„rt ayer
The above named Drain Layer has a valid license issued/ y the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
/O 'fX-�
Engineering Dept. Date
Permit Fee Paid $ "G-�+ Check Number / '/0/
Connection Charge Receipt No. ,( 3 V Dated /Ohz' ;
Issued by
INSPECTION
Date work started Date completed
Sufficient motif ic'a'f own rece ve : es No
Special Conditions
Lz
- Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: /G r TIME: c�
BY: iI< ?/ 122
FOR LOCATION � ;
DAB INSPEC. NEEDED /G -:�6 31 TIME:
TYPE OF INSPECTION: _
( ) SANITARY/LATERAL (PERMIT .NO. ] ' ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: % it TIME: INSP:
CONTRACTOR: v i�� WEATHER:
WORK IN PROGRESS: " i�:�- , .s=;� 77� =
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: