HomeMy WebLinkAboutDrain Layers Permit 15 Drake Court TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6087
15 orate- Cesar' IC719
Pursuant to written application, permission is hereby _granted to the
Lice sed Dr n L yer name h re perform the work indicated below at1
O l�'t I% 'e ises owned by .� �V �iOy�S'/
hose address is S aa�t — , '
an to
Lay douse Drain, Repair Pduse Drain, Lay Main, Other
for occupancy occupancy or use, with
Family Units,,Adith j/cam acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ( ) ,
INDUSTRIAL WASTES ( ) , OR (
Connection will be made with 3s
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
C
OSHA REQUIREMENTS MUST
B F
/� LOWS
SPECIAL CONDLTIONS
Desired Starting Date _'�----2_ — ? Estimated Time for. Completion`��>>, �y
Permit, to be issued toi��/I��
the holder of Drain Layer's License No. -Z P_Aaermit will expire thirty
(30) days after date of issuance. The undersigned Drain Layer hereby agrees
t.o , ill 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 -r ttt >
�Z �'.
Licens DrabI 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: a ,
En inee Dept. Date
Permit Fee Paid $ 1-� �Uo Check umber
Connection Charge Receipt No. c - Z- Dated f '
Lssued by
INSPECTION
Date work started Z 7 Date completed
Sufficient notifira on rece3've : es No
Special Conditions
APP 3--Z►�97
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 3- 7,1 ` 9 q- TIME: f-
BY: Awgjnn, FOR LOCATION: Q2 t' Z 7 � lsf r
DAY INSPEC. NEEDED - Z I 4-- TIME: I
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. 6 o o 7 ) ( ) FOOTING DRAIN
1
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: - Z TIME: INSP:
CONTRACTOR: WEATHER: OjO3.S a
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: