HomeMy WebLinkAboutDrain Layers Permit 172 Dogwood Lane ` TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5 ,
/o —/ Z 19 VU
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at /7- .P06 tvOOD
at premises owned by G f}P y k I N 6 Sn lj whose address is
and to
day 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.
F PV C-
� 00
SPECIAL CONDITIONS
Desired Starting Date /d - /S-- v Estimated Time for Completion
Permit to be issued to 7-0Yti W 14L 5k-1 P 5 P77 s e� U
the holder of Drain Layer's License No. o7 > 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 eceived
Town Permit No. and/or CHD Permit No. r'
Signed
censed 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 Town of South Windsor:
Engineering Department Date
Connection Charge Paid C e%o Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started 't�� Date completed L116/S 0
Sufficient notification re a ve'd: &/ Yes No
Special Conditions
APPROVED: / 496
In pector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' :
STREET: 7� ZWr
*SUBDIVISION:
IV
NH STATION : +
NORTH ARROW INVERT ELEV:
TIE TIE
6�
-FT T
HOUSE ___ _ LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV, INV. ELEV. BUILDING
(IF EXIST.) F (IF EXIST.)
�3 /
TIE TIE
Al
W STATION : +
1-6
INVERT ELEV:
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
STREET OCIA e SIGNATURE DATE
TOWN tt saj STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW —CONSULTING ENGINEER/DEVELOPER
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