HomeMy WebLinkAboutDrain Layers Permit 40 Daisy Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT N0 5744
199 Z
Pursuant to written application, permission is hereby granted to the
Licensed Drain La er nam d herein to perform the work indicated below at
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�t premises owned by y`Y� /clii�
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 ( "f,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with it
Show sketch of proposed work or furnish two C-2 copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date Awa Estimated Time for Completion /Orj
Permit to be issued 'to -
the holder of Drain Layer' s License No. f�.;21f . 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-fg n e
Licensed Drain Layer
The above named Drain Layer has a valid License issued by the State of
Connecticut and has filed a sat.is-factory b nd and insurance policy in the
name of the Town of South' Windsor. ,//r� Z
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E gin a ng Dept. Date
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Permit Fee Paid $ �j Chec umber 1�6
Connection Charge 'Receipt No. Ilated A 2
Issued' by Z
INSPECTION
Date work started ^� Z- Date completed 4 "Zo Z-
Sufficient notification rece ve : es No
Special Conditions
APPROVED: 92-
I ector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' : MI6
STREET: L4
SUBDIVISION: PeNCH�j(Z�jp(�
W STATION : ' 00 `MR #I
NORTH ARROW INVERT ELEV:
I
JL4
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_FT -FT.
HOUSE LATERAL LATERAL _ HOUSE
CONNECTION STUB STUB CONNECTION
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FT. FT.
BUILDING INV. ELEV. INV.ELEV. � VIV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) (IF EXIST.)
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STATION : #
INVERTELEV: ���°� CM H fib)
CONTRACTOR (PRINT) NAME F CONTRACT RCS SUPERVISOR(PRINT)
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STREET ADDRESS SIGNATURt DATE
p4010 6R)4 GT- 0 6(I
TOWN STATE ZIP INSPECTED BY TOWN DATE
( 2°3) -q3-X_,
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER