HomeMy WebLinkAboutDrain Layers Permit 186 Dogwood Lane (2) . TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N a 6201
/ 19-G
Pursuant to written application, p mission is hereby grante to the
Licensed Drain Layer named herein to p rform the work indicate a t
at remises owned by d II/M
whose address is nd to
Lay House Drain, _ R air Mouse' rain, Lay Main, Other
for o cupancy or se, with (41
Family Units , Vf1th acres .
Type of Sewage to be connected under this permit : SANITARY SEW GE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work\or furnish 'two 2) copies of separa drawings ,
C 6 y rj t tlQ(3 0 (_1 9 OSHA R=ITS MU$T tE FOLLOWEDy
SPECIAL CONDITIONS �-
Desired Starting Date SCp Estima`td- Tie for Completion t�
Permit to be issued t ( �l�
the holder of Drain Layerls Li ense No. rs Permit will expire thirty
(30) days after date of iss an e. The undeigned D ain Layer hereby agrees
to all the terms and conditi ns set forth in the per it and the reverse side
thereof . Applicant has rece ved Town Permit No . and/or
CHD Permit No. �
Signed
Li used Drain Layer
The above named ain Layer as a v i 1 ense issued by the State of
Connecticut and has file satis ctory bo d and insurance policy in the
name of the Town of South W sor :
C'I1K t e} ff- LSD
Engineering Dept. Date
Permit Fee Paid $ Check umber
Connection Charge Receipt No. �2, /7 ./ Dated
ChCrtc. r rs• ecic N��• 3.0 4Y
Issued by
INSPECTION
Date work started Date completed
Sufficient notification rece ve : _ es No
Special Conditions
APPROVED:
Inspector Date
�s fr✓O ®� fit/!! �IC L'��j��y
L
C(
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF R QUEST.-_ TIME: • D O
BY:
FOR LOCATION: ��(O
DAY INSPEC. NEEDED �� 5 `� TIME:
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO._ 46 c9,d ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: