HomeMy WebLinkAboutDrain Layers Permit 17 Diggins Court TOWN OF SOUTH WI N DSOR
` DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT L N! 6035
19 -3
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named h.ex
ein to perform the work indicated below at
premises owned by ��/', . �,Q
,' a t
Lay House Drain Re Ouse rain, Lay sin, Other
er
�"• •
occupancy or use, with
Family Units w th acres.
Type of Sewage .to be connected under this permit: SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , FOR ( )
' Connection will be made with skk 3 � �
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST B. FOLLOW D
SPECIAL CONDITIONS f
Desired Starting Date Es.timated- Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. af_,y. 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
Lice,Wed Dry n Layer
The above named Drain Layer has a val idlicense issued by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
Engine ring Dept. Date
Permit Fee Paid $ -0-3— 7J Check Number U j 0
Connection Charge Receipt No. '9379 Dated
Issued by
INSPECTION
Date work started Date completed Sufficient notification receive : yes No
Special Conditions
APPROVE
Inspector Date
i
} SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: gyp\ g� TIME: 2d
BY: FOR LOCATION: L �'
DAY INSPEC. NEEDED_ \0 0`�0� TIME:
TYPE OF INSPECTION:
) SANITARY/LATERAL (PERMIT NO. c ) ( ) FOOTING DRAIN
( ) EXCAVATION {PERMIT N0. ) ( ) OTHER
INSPECTION REPORT
DATE: / 0 - 7 -g 3 TIME• // "1 570 INSP: 6 �-
CONTRACTOR: C5� WEATHER:
WORK IN PROGRESS:
ck
S
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: