HomeMy WebLinkAboutDrain Layers Permit 6 Diggins Court TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER's PERMIT 6034
VGT � 19y
Pursuant to written application, permission is hereby granted to the
Liedl Ain` Layer named he ein� /to perform the work indicated Belo at
t ip,�lat remises owngd by 3 . 5 Cc�►S ,
whose address SC?• ?&f1: 0/_
Lay House
Dr in, Repa r Souse Drain, Lay Main,_}Oth r t�
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this
INDUSTRIAL WASTES { ), OR ( Permit: SANITARY SEWAGE
Connection will be made with S D R
Show s etch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUITS MUSTa
FOLLO ED
SPECIAL CONDITIONS ''?
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Desired Starting Date -- 3 Estimated Time for'
Completon-
Permit to be issued to >o C.-CSzVt�?S
the holder of Drain Layer's License No. 22 g 7�rQ , 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. Jf
SignedepOa
Licens Dra Layer
The above named Drain Layer has a valiAicense issued 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 $ °, U Check Number
Connection Charge Receipt No, 1 Dated
Issued by
INSPECTION
Date work started. ate completed
Sufficient notifica'f o �E---,��
Special Conditions
_..�_ Z e s N o
APPROVED,- R
Inspector Date
1 '
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: \�����g� TIME: o5 AM
BY: FOR LOCATION:
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO.=� ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
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DATE: TIME: ? 37 INSP:
CONTRACTOR: WEATHER: O °
WORK IN PROGRESS: `
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: