HomeMy WebLinkAboutDrain Layers Permit 555 Clark Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
�J BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4 1A 6007
/ 1955
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
//1 /jt at premises owned by Rsk--
whose address is ,i -4AI 7ZJAf 4 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
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date Estimated Time for Completion
Permit to be issued to "
"mot .�1
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 �Id-,,the permit and the reverse side
thereof. Applicant has received Town Permit ipo. and/�dr
CHD Permit No.
!
Signed
-censed Drain-,.Layer
The above named Drain Layer has a Valfd license issued by the State of
Connecticut and has filed a satisfactory bon and insurance policy in the
name of the Town of South Windsor:
Ar'ndineei,f ept. Date
Permit Fee Paid Checi _Timber
Connection Charge Receipt No.
g P _ �'i.�?� g Dated
Issued by
INSPECTION
Date work started 2 Q Date completed jQ- 5'-,93
Sufficient notificationn receive : y-7es No
Special Conditions
APPROVED• la-5;3?
nspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: z TIME: �:4 j
/^ c
BY: J iG�,., � FOR LOCATION: 4 -3
DAY INSPEC. NEEDED t-9' 3 TIME: r O
TYPE OF INSPECTION:
6�
( -SANITARY/LATERAL (PERMIT NO. Gaa1 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: - TIME: .;' l7 - _'dC1 INSP:
CONTRACTOR: 4�` WEATHER: S
WORK IN PROG ESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: