HomeMy WebLinkAboutDrain Layers Permit 62 Carson Way TOWN OF SOUTH WINDSOR
Cam_ DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 2 6297
Pursuant to written application, permission is hereby granted to the
Lcen, ed Drain Layer named her/ein to perform the work indicated below at
PA-111i011 t _premises owned by s
whose address is 6 V,5 ,a�cr, of S. (.�.�, and o
Lay House Drain, RepaJW House Drain, Lay Main, Other ,
for FAft G, occupancy or use,. with
Family Units , wi hacres .
..Type.. of Sewage to beconnected under ,this permit : SANITARY SEWAGE
INDUSTRIAL WASTES
Connection will be made with 5 D 9 3 5610inc
Show sketch of proposed work or furnish two (2) copies of separate drawings .
OSHA REQUIREMENTS MUST BE OLLOWE -- --
SPECIAL CONDITIONS � . -b
ye
Desired Starting Date >!77 —S- Estimated Time for Completion
Permit to be issued to � VAS
the holder .of Drain Layer ' s License No . �_ 29C30 . Permit will expire thirty
(3:0) days after date of issuance. The- unde:rsAgned ~Dr"ain Layer hereby agrees
to all the terms and conditions set forth in thepermit and the reverse side
thereof . Applicant has received Town Permit No , and/or
CHD Permit No .
Signed
License ra . ayer
The above named Drain Layer has a vali 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 Dept. Date
Permit Fee Paid $ 60' � ' Check Number 13S-2
Connection Charge Receipt No. P Dated
Issued by
INSPECTION
Date work started - 9� Date completed
Sufficient notificat on receives: Yes No
Special Conditions
APPROV
Inspector Date
SANITARY LATERAL &.EXCAVATION PERMIT:
INSPECTION REQUEST
DATE OF REQUEST z // -�-h TIME': c
BY: `Jb�1 t//�eC�G� FOR LOCATION: '%
DAY INSPEC. NEEDED 2-fl-� TIME:
TYPE OF INSPECTION:
( } S15NITARYILATERAL:° ('PERMIT-NG-- FOOTING DRAIN
( } EXCAVATION (PERMIT NO ) (/ ) OTHER
3 --r
INSPEC-TION.,I-EP-OR ., .
DATE.t,. /(--} S'^ TIME: INSP:
lj
CONTRACTOR: = WEATHER..
WORK IN' PROGRESS:
AZ&
AREA OF CONCERN:
: :SPECIAL INSTRUCTIONS: