HomeMy WebLinkAboutDrain Layers Permit 424 Clark Street 3"
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6055
Pursuant to written application, permission is hereby granted to. the
Licensed Drain Layer named herein to perform the work indicated below at
*2Z- /-/P' ' C l at premises� ,o)wned by
whose address is Z,p._/ P;494 wJ -'A2: 2j a1Wto
Lay House Drain, Repair House Drain, Lay Main,_ Other
for occupancy or use, with
Family with _acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with ,bR 3 tj ,
Show sketch of proposed work or furnish 'two (2) ` cop es of separate drawings.
SHA REQUIR ENTS MUST 13E FOLLOWED
SPECIAL CONDITIO qS , S s G,
Desired Star ing Date '� — Estimated Time for Completion
Permit to be issued to ..;� rjy� '�� e---1
the holder of Drain Layer's, License No. zx:>jrr5cv .. 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' k ^�
Licen d Drai Layer
The above named Drain Layer has a val licens issuedby the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
ng nee g Dept. Date
Permit Fee Paid $ 7j 0 0 Check ber / 74'4
Connection Charge Receipt No. Dated jZ��3
Issued by I,
`73
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
!s'Cti-�Gvo�s�G C� i�en,S . Gvxz '1 Z
y/L-gy APPROV
Inspector Date.
SANITARY LATERAL & EXCAVATION PERMIT
" INSPECTION REQUEST
DATE OF REQUEST: 3-23 TIME: 3 y
BY: /�/f91/(iY �J / J � FOR LOCATION: Y�f GGLfG 5
DAY INSPEC. NEEDED - 3-Z3�2-VTIME: 6UL,,7
TYPE OF INSPECTION:
( (� ) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. } ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP: �
CONTRACTOR: J/7/1✓ WEATHER: /lam/�Gf
WORK IN PROGRESS:
d2l,> d ZL4AR�
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: