HomeMy WebLinkAboutDrain Layers Permit 77 Carson Way x y
TOWN OF SOUTH WINDSOR
,. DEPARTMENT OF PUBLIC wORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ! �2Z9
19y r/
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
at premises owned by �1.s-� .� ►
whose address is and to
Lay House Drain, Repair Howe Drain, t/Lay Main, - Other_,
for cifo�C'„ fa occupancy or use, with :,d/.. �.�
Family�i nits, Oith - 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 .
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion PAS, _
Permit to be issued to
the holder of Drain Layer 's License .No . 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 .
Z I c 'irled rain Layer
The above named Drain Layer has a val Zdlicense 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 $ � Check Number QY�
Connection Charge Receipt No. e'z.-Z-2 Dated / Z -z,>-9
Issued by3
INSPECTION
Date work started /'Z—Z)-e15� Date completed
Sufficient notification receive -'Yes No
Special Conditions
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: /Z— Z� �/y TIME:
BY: /ZOGG'� �/� vL�f FOR LOCATION: 77
DAY INSPEC. NEEDED �Z " z7 "°!�{ TIME: l/�
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT .NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: /A�j INSP:
i
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
e�/l�l�'l/o�✓ � j7/��
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: