HomeMy WebLinkAboutDrain Layers Permit 10 Diggins Court WIN
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT6 184
19
Pursuant to written application, permission is hereby granted to the
Licepsyd Draip Lady r amed he a qq perform the work indicated belo at
/4f G/ . / i�/t premises owned by / Gq�s'
whose addres s o a to
Lay House Dr in, Repair use Drain., Lay Main, Oth-,er , 3
for occupancy or use, with '
Family Units'I with acres,
Type Type of Sewage to be connected under this permit : SANITARY SEWAGE ( ,
INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with 'SbA 3c, E'4�f'►^!)t�
Show sketch of proposed work or furnish 'two `'(2) copies of separate 'drawings.
EN
OSHA REQUIR S MUST F LLOWED
SPECIAL CONDITIONS OZ�l
P Desired Starting Date Estimated Time for Completion
Permit to be issued to �D kA Tgzj� 2('E' S
the holder of Drain Layer 's License No. 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- revers,e side
thereof. Applicant has received Town Permit No, and/or -
CHD Permit No.
"Signed
Lic sed in Layer
The above named Drain Layer has a val d 11c se i ed ':by the 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 $ ,�D Check Number.
Connection Charge Receipt No. 1016D0 Deted
co. O ou
Issued . by42
.
. INSPECTION -
Date work started C/ - ° Dat impleted
Sufficient notifica on race ve : es No
Special Conditions
APPROVED:_I spector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: g' -/Q--f°� TIME:
BY: bx FOR LOCATION: Gam'/ f Ie—1
DAY INSPEC. NEEDED TIME: -56) j-owl
TYPE OF INSPECTION:
( ( ) SANITARY/LATERAL (PERMIT NO. CI_ `Z) ( j ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( `) OTHER
INSPECTION REPORT
DATE: TIME: i �✓� INSP•
CONTRACTOR:— WEATHER:
WORK IN PROGRESS:
7�,�1-' d�c--�G'�- ���- �>� I2�7�t-=/�=��� ,may✓"
Ake
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: