HomeMy WebLinkAboutDrain Layers Permit 10 Cody Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT Q 6121
-- 5 7 19.
Pursuant to written application, permission is hereby granted- to thet
License/i ainLayer ri med herei� form the work indicated below at.
,l ?" emises owned by ✓jYJ�j �5
whose address is ' and to.
Lay House Drain, Repair ouse Drain, Lay Main, Other_
for occupancy or use, with
Family Unit with acres. /
T, a ,,pf . Sawa �—
yP g� to be connected under this permit : SANI'TAItY SEWAGE ( ,
INDUSTRIAL WASTES .OR
Connection will be made with 3,g-
Show sketch of proposed work or furnish 'two (2) copies of si irate drawings .
i
OSHA REQUIR MEN S MUST BE FO ,LOWED
SPECIAL CONDITIQNS 4,, rJ
Desired Starting Date �j-'-� �"7—y'Cl Estimated Time for Completion
Permit to be issued to `TDI�hGd�VLS
the holder of Drain Layer ' s License No.
'2,Pj4$$3E� Permit will expire thirty
(30) days after date of issuance. The' undersign,e.d Drain Layer hereby agrees`
to all the terms and conditions set forth in the permit and the .r.evers.e side
thereof . Applicant has received Town Permit No. and/or
CHD Permit No.
Signed. �.
Licens Dr Layer
The above named Drain Layer has a valid license issue by ,the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor
Z7
n in ig`4N ng Dept. ' Date .
Permit Fee Paid $ Check umber z:-T7/
Connection Charge Receipt No. 44 3-7 Dated 2-
Issued by Z
INSPECTION
Date work started Date completed
Sufficient notification receive es No
Special Conditions
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST:- - Z l- �/ TIME
BY: �� FOR LOCATION:
DAY INSPEC. NEEDED a, ZZ- jGf TIME:
TYPE OF INSPECTION:
( x ) SANITARY/LATERAL (PERMIT NO. !�,/2-7 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: Z2- TIME• INSP
CONTRACTOR: WEATHER: G�L
WORK IN PROGRESS:-
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: