HomeMy WebLinkAboutDrain Layers Permit 42 Daisy Lane r TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ° No 5745
1114V 19 9 Z
Pursuant to written application, permission is hereby granted to the
Lic ed Drain Lay r,named herein to perform the work indicated below at
4 �Z / ,0 11fle at premises owned byj-G�,
whose address ism 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 R
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to (rt�� �-'l- GtJtu_mw.s
the holder of Drain Layer 's License No. �' ,2� .. 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 i g fi a X Z2
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory b nd and insurance policy in the
name of the Town of South Windsor :
E gine ng Dept. Date
vv c
Permit Fee Paid $ �� Check umber
Connection Charge Receipt No. L ated__a q 9Z
Issued by M4IT L
INSPECTION
Date work started / �/3 r ��_ Date c�c mpleted
Sufficient notif ica on receiver:_,Yes ` No
Special Conditions
APPRO ��-97
'Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' : LIB
STREET: DR15'/ L PR .
SUBDIVISION: Prpvci-i a<c-
LATt�I}' L To +bu5c
Dt*r O r co It 1*1 1
NH STATION : + 00 (mm�lI)
NORTH ARROW INVERT ELEV:
a
TIE TIE
_FT -FT,
HOUSE LATERAL LATERAL _ HOUSE
CONNECTION f STUB STUB CONNECTION
FT. _152.2-L FT.
BUILDING INV. ELEV. INV.ELEV. � INV. ELEV. INV. ELEV, BUILDING
(IF EXIST.) (IF EXIST.)
TIE 1 TIE
NH STATION : (VA 16)
INVERTELEV: 5 °13
H• W IE,�-rl>�rrvt5 S��IS GZja, HJt07 $, -6 01 )
CONTRACTOR (PRINT) NAM F CONT C ORBS SUPERVISOR(PRINT)
3 5'1 M�wAIO AD
STREET ADDRESS SIGNAT DATE
1l iNG1_0 C1 0(yill
TOWN STATE ZIP INSPECTED BY TOWN DATE
�3 ) facofo T `I 37(a
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER