HomeMy WebLinkAboutDrain Layers Permit 31 Daisy Lane TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL -
DRAIN LAYER'S PERMIT g"No 5788
Pursuant to written app.lication,. permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
3 1 1-)YJts, e L.o9n�e at premises owned by 1 6-oV" ✓L
whose address is and to
Lay House Drain, Repair House Drain., Lay Main,; Other ,
for occupancy or use, with
Family Units, with. acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ( ,
INDUSTRIAL WASTES (, ) ,` OR
Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITION`S
Desired Starting Date Estimated Time for Completion
Permit to be issued to 14)
the holder of Drain Layers License. No, G " 25' ,: Permit will expire thirty
(30) `days after date of issuance. The undersigned Drain Layer hereby agrees
to all the terms and conditions set forth in- the permit .an.d the reverse side
thereof. Applicant has received Towri Permit No. - and/or
CHD Permit No.
S n e d G sic / Get r ` �-•."'
Licensed Drain: Layer
The above named Drain Layer has a valid license issued 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 $ I�Plsl Check Number 02R0g9
Connection Charge 'Receipt No. Dated
Issued by
INSPECTION
Date work started to completed
Sufficient notification ece ve - es No
Special Conditions
APP -
r
Inspector ate
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FI EL LOCATION
DATE OF CONSTRUCTION: 3 -0-L
BUILDING ADDRESS OR LOT N' : -� I
STREET: OPf1SY L_4 ,
SUBDIVISION: 'Pg1Fobecoyai
NH STATION : +
0U �lhI I�
NORTH ARROW INVERT ELEV: 115
i
TIE TIE
FT. FL
HOUSE LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. ISI.r� FT.
BUILDING INV. ELEV. INV.ELEV. INVU. . ELEV. INV. ELEV. BUILDING
(IF EXIST.) (IFEXIST.)
TIE TIE
AM STATION : 0 2S 6,n,, -a lo)
INVERT ELEV: 151 ,13
W 1, W IL.c*05 450,45 R5� �1'0IN*R— UM 8LIJ2 S
CONTRACTOR (PRINT) NAME CONTg.A£ �S SUPERVISOR(PRINT)
351 motAgrh,a ,
STREET ADDRESS SIGNATURf DATE
A 7w► 4 6-rbA , GT I)6 II►
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER