HomeMy WebLinkAboutDrain Layers Permit 2321 Ellington Road -,,,tw�osnr:. c ... ..i• <" ", px•^. ,..k ::x fif.. ..M ,.
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT *61 4 4
Pursuant to written application, permission is hereby granted to the
Licensed Dra `-n L yer med herein to perform the work in cated:,b.Q
_ ,l�1 I at remise owned by ryhr; k rt s (1
whose address s �G —and to
Lay Hous Drai , 1N Repaiir ouse Drain, Lay Main, Other
for 1 ' �Yz occupancy or use, with
Family Units , with _acres.
Type of Sewage to be connectedunder this permit : SANITARY SEWAGEj ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
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` OSHA REQUIREMENTS MUST BE FOLLOWED
` SPECIAL CONDITIONS
Desired Starting. Date Estimated Time for Completion .
Permit to be issued to 04.40 ,,� '7i 4,""
the holder of` Drain Layer' s Lice/hs`e No. Z 06 (, f 8 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
Li ense Drain Layer
The above named Drain Layer has a val 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 ` Dept. Date
0
Permit Fee Paid_'$ -9z4tW Check Number
Connection Charge Receipt No. 4.1- 7Z Dated
Issued by +
INSPECTION
Date workstarted �9 ' Date compl;epe'd
Sufficient notification rece v —Yes No '
Special Conditions
APPLOVED
ns ector Date
i
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: - - / TIME: Q
BY: ,�._ FOR LOCATION: �I e
DAY I SPEC. NEEDED TIME: �e�O
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. l ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT N0. ) ( ) OTHER
INSPECTION REPORT ��nn
DATE: �J— Z--9 c= TIME: � - /�Oc� INSP:
CONTRACTOR: �,ow-k WEATHER:
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WORK IN PROGRESS: D�2 'o te 4 af.�t.L
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AREA OF CONCERN: Li 4&
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SPECIAL INSTRUCTIONS: ����w ,cam ti� t - �''v a2
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME: `
BY: ��(� FOR LOCATION: Z 3 Z I Tt
DAY INSPEC. NEEDED: C� TIME: A G
r a
TYPE OF INSPECTION:
( �} SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN
EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: Z—C7" 3 TIME: g o INSP:
CONTRACTOR: WEATHER: rj
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WORK IN PROGRESS:
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SPECIAL INSTRUCTIONS:
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