HomeMy WebLinkAboutDrain Layers Permit Lot 29 Daisy Lane y TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
y . o 5741
DRAIN LAYERS PERMIT N_
19
Pursuant to written application, permission is hereby granted to the
/ Licensed Drain Lay r. named herein to perform the work indicated below at
LCT�� ,+ars , at premises owned by /���`y, lte&e
whose addre s is 0 Z Gl/�,J ' .�cx/Z /T/yv ri- Cam . 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) Vccopies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated, Time for Completion
Permit to be issued to ///"v�'h
the holder of Drain Layer 's License No. .d BZS� 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 and the reverse side
thereof. Applicant has received Town Permit No. and/or
CHD Permit No.
Signed
Licensed Drain aver
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:
E n ering Dept. Date
i
Permit Fee Paid $ 2S� Check ber (.-:)ED
Connection Charge Receipt No. ated /c
Issued by 4A4 �15;
INSPECTION
Date work started "��� Z Date completed ^
Sufficient notification receives —Yes No
Special Conditions
APPROVED:
n pector Date
,. TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N° : 2QI
STREET: IDAISY LA .
SUBDIVISION: Pop�cNoe-obKC
Ni STATION : ( .�. 00 (MI44,11)
NORTH ARROW INVERT ELEV: ,51•
TIE TIE
FT. FL
HOUSE LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. FT.
BUILDING INV. ELEV. INV.ELEV. U. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) OFEXIST.)
'Z5.5 ',-
TIE TIE
W STATION : 0 + 1S
INVERT ELEV: 15 1,1 3
WA. W 1u,1fA5 � Sor/S UeG H f rj QwR - Q(Zorv\
CONTRACTOR (PRINT) NAME F CONTRACT 'S SUPERVISOR(PRINT)
STREET ADDRESS SIGNATURIf DATE
NS1,410 A CT obi I
TOWN STATE ZIP INSPECTED BY TOWN DATE
C �3 ) for&- W37(c
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER