HomeMy WebLinkAboutDrain Layers Permit 86 Carson Way R
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
C,,�s�v, DRAIN LAYER'S PERMIT N 12 6066
12- —/ i9z--3-
Pursuant to written application, permission is hereby granted to the
Licen e�i Drain Layer tame her gin to perform the work indicated below a
�V 1 )AP- u.4Dpre ise owned y �'' CU S
whose address is S' / ' S � to
Lay House Drain,, Repair 8o a Drain, Lay Main, Other
for Ge-,0,/ Z occupancy or use, with ,��,�,�A
Family Units, wi _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 B FOLLO,WED
SPECIAL CONDITIONS1Ty_ , � �
Desired Starting Date Estimated Time for Completion i
Permit to be issued to , Ues.
the holder of Drain Layer's License No. 2dV3_: 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
Lice;Y ed D, ain Layer
The above named Drain Layer has a val d licen e issued by the State of
Connecticut and has filed a satisfacto y and and insurance policy in the
name of the Town of South Windsor:
Eh-gin ng Dept. Date
Permit Fee Paid $ Chec Number I Z.
Connection Charge Receipt No. - 1 Dated
Issued by
INSPECTION
Date work started /2. - Z.Z .,q Date completed IL- 7_2 -!q
Sufficient notification receive ; es No
Special Conditions
APPROVED:
spector Date
SANITARY LATERAL & EXCAVATION PERMIT
- INSPECTION REQUEST
DATE OF REQUEST: TIME
BY: FOR LOCATION:
DAY INSPEC. NEEDED TIME:-
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
{ ) EXCAVATION {PERMIT NO. ) { ) OTHER
INSPECTION REPORT
DATE: IS - 22, 3 TIME: 6` NSP:
CONTRACTOR: M WEATHER: 3 0 o- -F
WORK IN PROGRESS. ^ �
a
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST- -- -
DATE OF REQUEST: / Z I S 9 ,3� TIME: O
BY: 0 FOR LOCATION:
DAY INSPEC. NEEDED 22 -( 5'-,95 TIME:- / ; 30
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. ® 66 ) ( ) FOOTING DRAIN
{ ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 12 TIME 1`/ D 0 INSP:A&Iwa
CONTRACTOR: S ' WEATHER: s ® •
WORK IN PROGRESS: , Do
Z-
l 2 16 . /
0.
2®-
AREA OF CONCERN:
SPECIAL INSTRUCTIONS :