HomeMy WebLinkAboutDrain Layers Permit 50 Cody Circle r TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
(( DRAIN LAYER'S PERMIT 6278
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19
Pursuant to written application, permission is ereby granted to the
4icensed Drain ,Layer name herein to perform the work indicated below , t
at pre ises owned by
ose address s ® to
Lay House Drain, Repa r se Drain, Lay Main, Other ,
for " occupancy or use, with VIA
Family 'Units'/with acres .
p r °`Type -of Sewage to b-e `connected under this permit: SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed ..work or furnish two '(2) copi s of separate drawings.
OSHA REQUIREMENTS MUST BE OLLO D
SPECIAL CONDITIONSIAOGA. 0464
Desired Starting Date 30 Estimated Time for' Completion
Permit to be issued o _ ~ bb T46420cs
the holder of Drain Layer' s License No . Permit will expire thirty
( 30) days after date of issuanee. The, under6igned Drain Layer hereby agrees
to all the terms and conditions set:,; forth in the permit and the reverse side
thereof . Applicant has re�c,eived Town ' Permit No . and/or
CHD Permit No .
Signed
L cs?4d D in Layer
The above named Drain Layer has a vali licenis ued by the State of
Connecticut and . has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor :
,.dy. Enginee ing Vept . Date
Permit Fee Paid $ Check Number 6
Connection Charge Receipt No. Dated . "- 23 j 9' y�
Issued by
INSPECTION
Date work started �" 7� 9 Date completed �j --S'`9 5
Sufficient notification received : yes No
Special 'Conditions`
APPROV'
Inspector Date
SANITARY LATERAL.&. EXCAVATION PERMIT
s
f INSPECTION REQUEST
t : DATE:. OF REQUEST [S TIME::
BY:;., 'C'- FOR LOCATION: t
DAY INSPEC. NEEDED wC1OLk,
TIME: 0, !� n
TYPE. OF INSPECTION:
( ✓ ) SANITARY/LATERAL..'tP�ERMITI NG. C' � ) (.
FOkIT..IbiG;; DRAaIN:::..
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECT-10W,.REP,01
._
DATE.: ^,�9 S TIME: INSP:
r CONTRACTOR':-, WEATHER— � ° f
WORK-.. IN: PROGRESS: .
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t l� U
W ✓"' Ig
AREA OF CONCERN:
` SPECIAL INSTRUCTIONS: