HomeMy WebLinkAboutDrain Layers Permit 2140 Ellington Road y . TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
- DRAIN LAYER'S PERMIT 6256
19
Pursuant to written application, permission is her by gra .ted to the
Licensed Drain Layer named herein to perform the work ind Cate below at
, o at premises owned by ,F� ( �cI x
whose address is v S*A"f and to
Lay House Drain, _Repair House Drain, Lay Main, Other
for I �! ^ /4 ,L, 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 Cp
Show sketch of proposed work or urnish two (2) copies of separate drawings .
OSHA E FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated T me fo Completion
Permit to be issued to
the holder of Drain Layer' s License No. a-o`)c�q 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 permitAand the reverse side
thereof . Applicant ha re eived Town Permit No . and/or
CHD Permit No. S 1 Q EC)
Signed
5S
L c sed Layer
The above named Drain Layer has a valid li ense is a by the State of
Connecticut and . has filed a satisfactory bo d an insurance policy in the
name of the Town of South Windsor :
n ine g Dept . Date
Permit Fee Paid $ ,j0 Check umber �{
Connection Charge Receipt No. S3 ated _
Issued by
INSPECTION 77
Date work started 5j-4� Date completed
Sufficient notification tees ve a es No
Special Conditions /`v1T/GGv� G✓GGia� v1/'
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: :l 6 TIME: Z l�-,---`Lf
BY: FOR LOCATION: Z f D
DAY INSPEC. NEEDED ��(O�GJ� TIME: q 5�
TYPE OF INSPECTION:
( (/ SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: GJ 07-9'S, TIME:_ i7� INSP: D
CONTRACTOR:- �(/(� Cps�r WEATHER:
WORK IN PROGRESS: �'/,�y�Y //ySj"�-<.LG:� L./,ziN7y,�� r,�'�•�
AREA OF CONCERN:
___ _ SPECIAL INSTRUCTIONS: