HomeMy WebLinkAboutDrain Layers Permit 79 Charing Road TOWN OF SOUTH WNDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL '
A
DRAIN LAYER'S PERMIT No 6246
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75
Pursuant to written application, permission is hereby granted to the
L ' c n ed Dra ' Layer a ed herein to perform the work in4j ated beV
� w at
.S ct at premises owned by (�� �C ,
r
whose address is and Co
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 within P
Show sketch of proposed work or furnish two (2) copies of separate drawings .
OSHA` REIZ Ibl tPMENT9 MUST` BE� `FSQL ;CiTrTED
SPECIAL ,.CONDITION$
r y.t („ A
C Desired ,Strg Date X*Zestimated Time for Completion
Permit to be issued to Vl...
WN5772- �j�'
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 •p`ermit and the reverse side
thereof . Applicant has received Town Permit No . and/or
CHD Permit No.
Signed
Li en ed 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:
440 - �
Engineering Dept . Date
Permit Fee Paid $ i0y Check Number 0004o `
Connection Charge 'Receipt No . Dated ,�L'G�"- '9`�ov
Issued by '3/
INSPECTION
Date work started q --- Date compleete.d - 7 R5
Sufficient notification r ceivea :
Special Conditions
A-
A P P R 0 V!,E
Inspector . :. to
7y n f j
SANITARY LATERAL & EXCAVATION PERMIT
a ` INSPECTION REQUEST
DATE OF REQUEST: W44 . 3 , 9 TIME:- f,,3 0
BY: � ,� FOR LOCATION
4��� �/
T
DAY INSPEC . NEEDED `7"M. 99 rJ, IME:
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT NO. l0 Z 10 } ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( } OTHER
INSPECTION REPORT
DATE: r 9 Ass TIME: /® ,'30 - .3;0 d INSP: ��
CONTRACTOR: WEATHER:
WORK IN PROGRESS: ,
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: