HomeMy WebLinkAboutDrain Layers Permit 185 Diane Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5136
Pursuant to written application, permission is hereby gra ted to_the�Licensed Drain Layer
named herein to. perform tpje�wor in icated below at
,granted
at premises owned by yV 4 ~ �4-mac Ems. whose address is
l 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.
�_j
0V I r ()a �
SPECIAL CONDITIONS CK
Desired Starting Date "7 -' "�—' Estimated Time for Completion
Permit to be issued to c-
the holder of Drain Layer's Liceftse No. c> '0 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 i
L�1
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 To of South Windsor:
� / Engin ering De p rtment Date
`/1
Connection Charge Paid n 216 /e�( Permit Fee: Paid $ S Z 7 7
�-� Check Nurqber 4 3 _3
�°►� i�Lt6< �r"� Issued by
Tax Office /
l l
INSPECTION
Date work started 8f1' _ Date completed
Sufficient notification rece ved: Yes No
Special Conditions ti .0 .ock 1'o Ard/ "0000'i4,0 a1^ 6y /y,►� cc 6y
APPROVED:
Inspector at
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: /O In/gy /
BUILDING ADDRESS OR LOT N': ,�,�
STREET:
'V SUBDIVISION:
1,
NH STATION :
NORTH ARROW INVERT ELEV: 7•
a
e
TIE TIE
FT
-FT,
HOUSE _____ LATERAL LATERAL HOUSE
£ CONNECTION
7 � STUB STUB CONNECTION
FT. FT.
In
BUILDING INV. ELEV. INV.ELEV. INVU. . ELEV. INV. ELEV. BUILDING
(I EXIST.) r \ (IF EXIST.)
rLong
5Q,0'l' 1E TIE
/jt
_,jcon
U �- NH STATION :�t v �"
y
INVERT ELEV: `r
Wr'o
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR(PRINT)
� 77 50/ IvA k, Y. y :
STREET ADDRESS I NATURE DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
) Q2 9
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER