Loading...
HomeMy WebLinkAboutDrain Layers Permit 49 Charing Road TOWN OF SOUTH WINDSOR �+ DEPARTMENT OF PUBLIC WORKS 1 BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT / �2 17 4`° L qfV Pursuant to written application, permission is hereby granted to the Li ensed Drain Zayer med h rein to perform the work indicated below q C4 at premises owned by � �� G�.jY• whose address isrand to Lay House Drain,- epair House Drain, Lay Main, Other , for occupancy or use, with Family Units , with 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. SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED Desired StartingDate Estimated Time for Completion Permit to. be issued to -�t t 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 icensed Drain Layer The above named Drain Layer has a valid 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 : ` /2- !o Engineering Dept . fDAte Permit Fee Paid $-CA� ,QCO Check Number � `� Connection Charge Receipt No. Dated 9- 12 Issued by INSPECTION Date work started - Date completed - 7 - Sufficient notificarlon rece ve : A7 yes No Special Conditions Inspector Date SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: f Z b 9 TIME: 4d-,M. BY: !J , FOR LOCATION: Z DAY INSPEC. NEEDED f 2 r � TIME:- ,d �¢ s TYPE OF INSPECTION: ( SANITARY/LATERAL (PERMIT NO. 4 Z ) ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( } OTHER INSPECTION REPORT �A / DATE: TIME: Z', Q © INSP: CONTRACTOR: WEATHER: WORK IN PROGRESS: L / t AREA OF CONCERN: SPECIAL INSTRUCTIONS: