HomeMy WebLinkAboutDrain Layers Permit 38 Daisy Lane i TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL p
DRAIN LAYER'S PERMIfi �0 578
2
�U ri 0- 19-
Pursuant to writ,t;en application, permission is hereby granted to the
Licensed lkrain La e,r named herein to perform the work indicated below at
at premises owned by ?)Y-2M �c4n s
whose address is tv c. "s - and to
-Lay House Drain, Repair House Drain, Lay Main, Other
forwc, occupancy or use, with
Family Units, with acres.
k Type of Sewage to be 'connected under this permit: SANITARY SEWAGE ( ,
INDUSTRIAL WASTES ( ) , OR
i Connection will be made with TU C
Show sketch of proposed work or furnish two (2) copies of separate drawings.
H no-s
SPECIAL CONDITIONS
Desired Starting Date Estimated. Time for Completion
Permit to be issued to
the holder of Drain Layer 's License No atjg2S�S�•. 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.
S,�±�dLU
License rain Layer
The above named Drain Layer .has a valid license issued by he 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 $ �j;�� Check Number d27\0
Connection Charge Receipt No. at,/�J�"[�, Dated
Issued by
INSPECTION
Date work started Date completed' U--'92--
Sufficient notificaTion received : es No
Special Conditions
APPP4RXa , %j 9z
Inspector Date
Y 1 '
• TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' : 7lb
STREET: VPt15Y LA
SUBDIVISION: P9l'kcHfP_0o I
C �11
NH STATION : _L_+ 00 NON
NORTH ARROW INVERT ELEV: , I �
` C�y
TIE TIE
-FT -FT,
HOUSE ___ LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. ✓I.col FT.
BUILDING INV. ELEV. INV.ELEV. rlU. LEV. INV. ELEV. BUILDING
(IF EXIST.) (IF EXIST.)
TIE rTIE
ATION • fCm H Ia)
t
INVERT ELEV: 1510
W IL.L14rA 5 t SDd5 6o4G WI 00K -dam 00B,
CONTRACTOR (PRINT) NAME�OFFCNTRALTO #S SUPERVISOR(PRINT)
STREET.ADDRESS SIGNATU DATE
HI W1► obd , CT- C)&I)1
TOWN STATE ZIP INSPECTED BY TOWN DATE
26�3) Cc�o�- y3•��
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER