HomeMy WebLinkAboutDrain Layers Permit 39 Cody Circle i.w.-. -^rn.. a_wv+--r�,ra'GsSR.a•-�.��.*-..s-+yr.vtr.+7^itm�. �, �a� , .°4 }cq;"7r+!3. ._ ... h . ,uy;,> ,�
TOWN OF SOUTH WINDSOR
pr DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6154
Z� 22 , _1q
Pursuant to written application, `permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
E L,pT�ZS�- a t remises $wn e d by ale� ,_ AoAr_
whose address i.s 6 an to
Lay House Drain, Repair ouse Drain, Lay Main, - Oth.e
for occupancy or use, with
Family Units,,/ with J acmes
Type of Sewage`s�'o be connected under this permit : SANITARY SEWAGE
..INDUSTRIAL WASTESt( l) , OR :( )
d-9nnection will be made with SDR 3
Show sketch of proposed work or furnish 'two (2) copies of separate drawings
OSHA REQUI EMENT MU,S,T E FOLL WED
SPECIAL CONDITIONS %�29 Gc�
Desired Starting Date Estimated Time for Completions/
Permit -to be `,issued to - 55 Ut--5
the holder of Drain Layer's License No, 2t0$g3D . Permit will expire thirty
(30) days after date of issuance. The undersigned Drain Layer hereby agrees
to all the; terms and - co
nditions set forth in the permit and the reverse side
thereof . Applicant has received Town Permit No. and/or
CHD Permit No,
Signed`" -�
Lice;Zs
Dra ' Layer
The above named Drain Layer has "a valid�/iicenssu by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
Engin i lkl Dept. ^ .•e
PerAit Fee Paid $ Check Number
Connection Charge, Receipt No. Aj ya?) Dated.
Issued byy
INS ECTION
Date work started '°7 Z,(g 2 Date completed z6 ��
Sufficient not-ificalion receive a ; ' Yes No
Special Conditions
APPROVED:
Inspector Date `/`
! SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 2 6 TIME:
zz t J O
BY: FOR LOCATION: n� 4frZS
DAY INSPEC. NEEDED 7- TIME: f �•� d
TYPE OF INSPECTION:
(�) SANITARY/LATERAL (PERMIT .NO.� ) (X ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
2- TIME: l INSP:
DATE• — E � � .3
CONTRACTOR: WEATHER: /C�
WORK IN PROGRESS:
. / r
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: