HomeMy WebLinkAboutDrain Layers Permit 69 Charing Road PW
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION.CONTROL
DRAIN LAYER'S PERMIT
6247
19
Pursuant to written application, permission is hereby granted to the
JLicense Drain Layer amed herein to perform the work indicated below at
L C��, cP �X�, at premi es owned by 61 ,1/Crl
whose ddres"s i ch - and to _
Lay House Drain, Repair 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 G_
Show sketch of proposed work or furnish two (2) copies of separate drawings'.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date �-- C/ Estimated Time for Completion
Permit .to be issued to r00-r1/
the holder of Drain Layer ' s License No. - .off/S Z, 'Permit will expire thirty
( 30) days after date of issuance. The undersigned Drain Layer hereby agrees
to all- the . te.rms and conditions set forth in the permit and the reverse side
thereof . Applicant has received Town Permit No. and'/or
CHD Permit No .
Signed
Licensed 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 : jj ZA
-
Engi , ring Dept. Date
Permit Fee Paid $ Check Number 0004 59
Connection Charge Receipt No. S:Q Dated Z-?e-7J
Issued by 3 7
INSPECTION
Date work started ,� ' 7- Date completed 3- 7-
Sufficient notification rece 3tv a es No
Special Con it ons � rr
o .
APPROVED• (✓ 9e;;
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST:, �J, /9Qs TIME:
BY: Z :O D r"m ,ed71 12214-4 FOR LOCATION:
DAY INSPEC. NEEDED 714p QP� _ TIME: Zoo r '?o
TYPE OF INSPECTION: r
( ) SANITARY/LATERAL (PERMIT NO. 9?- 4-7 FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. } ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP:
`mot a�. 3 /QQ s /� ,�3� A��. df4��
CONTRACTOR: WEATHER: ajjjrW
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WORK IN PROGRESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: