HomeMy WebLinkAboutDrain Layers Permit 65 Cody Circle .. ., ....,a,�r-a r:xcag�.; 7's.•ma•.'^t'_-.cgr.'^.7.�fFT , .... - r
TOWN OF SOUTH Wi N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT - No153,
,
Pursuant to written application, permission :is hereby granted _to the
Licensed Drain Layer named herein to perform the work ` indicated, _below at,.: .. -
Z A,/ Ce i`Z at premises 'owned by C,[/¢�P�tG 2, 50%
whose address is . ,4— C./ d to
Lay Hou a Dn in, Repair House Drain, L' Main,. Other
for occupancy or, u' , with 3/111,1•�
Famil its with acres.
Type of Sewage to be connected under this perm`"' : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) . OR ( )
Connection will be made with .3,T rni he
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREME�iTTS UST BE F LOWED
SPECIAL CONDITIONS G O
Desired Starting Date Estimated Time for Complet_i'on
Permit to be issued to
the holder of Drain Layer ' s License No. Permit will expire thirty
{30) days after date of .issuatce. The undersigned Drain Layer hereby agrees
to all the terms and conditions set . f.orth in the permit and the reverse side
3t ereof . Applicant has received Town Permit No. and/or,I,:
CD Permit No. —
Signed
Lic ed ain Layer
The above named Drain Layer has a vali license _is. ued by the State of
(' Connecticut and has filed a satisfactory bond and insurance . policy .in the
name of the Town of. South Windsor :
Engineering Dept. - -Date
Permit Fee Paid $ ZS Check Number �y
Connection Charge Receipt No. Dated '7tlAl
Issued: by3�
INSPECTION
Date work started Date completed (_-t �..
Sufficient notific—aTion eceiv* a: _� 'Yes No
Spectal Conditions
APPROVE
Inspector ��.Date
r SANITARY LATERAL & EXCAVATION PERMIT
r INSPECTION REQUEST
K, DATE OF REQUEST: 7 ~ 6 `q
4L-- TIME:—
BY: jLtFOR LOCATION�: .,c -2 7
DAY INSPEC. NEEDED 7-2—G" 9k TIME:
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. J S 3 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
Z
DATE:- � — � �� � TIME: P 3 p INSP:
CONTRACTOR: t�jGl WEATHER:
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: