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HomeMy WebLinkAboutDrain Layers Permit 50 Cody Circle (2) TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT ' 19 Pursuant to written application, permission is here y granted 'to the Licensed Pr n Layer named erein to perform the work indicated below t © t [ 1D� i o w e d Y $ . whose" address fi o ro c�. ' �-OP- a to Lay House Dr in, Repair H se, Drain, Lay. Main, Othe)r-- , for occupancy or use, with Ti/! /� Family Unit , with acres. Type of Sewage to be connected under this permit : SANITARY SEWAGE ( ) , INDUSTRIAL WASTES ( ) , OR _Connection will be made with j Show sketch of proposed work or furnish 'two (2) copies of separate drawings. OSHA REQUIREMENT UST B PO OWED SPECIAL CONDITIONS GJ. - G3 Desired Starting Date z Estimated Time for Completion Permit to be issued -o �'f � CaUC'S' the holder of Drain Layer' s License No. O' Q. Permit .will. expire thirty (30) days after date of issuance. The un ersigned 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 /ndand cen a Dra Ayer _ The above named Drain Layer has a vatnse issu by the State of Connecticut and has filed a satisfactory b insurance policy in the name of the Town of South Windsor: -03-°r Engineering Dept. Date� Permit Fee Paid $ �. CSC) Check Number ~ Connection Charge Receipt No. yu 7- Dated " 9~94 Issued by G INSPECTION Date work started 69P/2-- %'� Date completed Sufficient notificafio'n receive `: T7yes No Special Conditions APPROVED: Inspector Date _SANITARY LATERAL & :EXCAVATION PERMIT INSPECTION REQUEST DATE )OF REQUEST: TIME: A BY: �J '7 FOR -LOCATION: /✓��C1�% �=/ � , r p Gvlw ' DAY IN,SPEC. NEEDED ���� TIME: TYPE. OF INSPECTION:z ( ) SANITARY/LATERAL (PERMIT, 'NO, ) ( ) FOOTING/DRAIN ( } EXCAVATION (PERMIT NO,. ) ( ) OTHER INSPECTION REPORT DATE: TIME: INSP /i CONTRACTOR: WEATHER: CAifil WORK IN -PROGRESS s, i AREA OF: CONCERN: ` SPECIAL INSTRUCTIONS: