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HomeMy WebLinkAboutDrain Layers Permit 141 Fairview Drive X TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL c DRAIN LAYER'S PERMIT f., Q Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below at 1 11 t 11wi Ew at premiss-es owned by MAatON Siptz I whose address is 141 Aiaview and to Lay House Drain, X Repair House Drain, Lay Main, Other for f1lUN4Ti114.. occupancy or use, with ©�E Family- Units, with acres. Type of Sewage to be connected under this permit : SANITARY SEWAGE A/ INDUSTRIAL WASTES ( ) , OR ( ) Connection will be made with17y� F Show. sketch of proposed work or furnish 'two (2) copies of separate drawings, SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED Desired Starting Date 10-31-rLA. Estimated Time for Completion , Z OA)(j Perm.i.t to he issued to MES Act'1'i3 the holder of Drain Layer's License No. 0 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. Signecj -- Licensed Drain Layer The above named Drain Layer has a v,. - d 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 Permit Fee Paid $ .,-5 ' Check Number c.� � Connection Charge Receipt No. Dated '- Issued by INSPECTION Date work started fp. /Date completed Y .-. g S-u-f f,i c3.e:n-t_- n o t L f i E aT 13 n r e c e v e . e s .N.o- ---- __ �--- — _ Special Conditions APPROVED' -1 Inspector Dat SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: /0 TIME: BY: \�G�� �'S ✓ G'' C� FOR LOCATION: DAY INSPEC. NEEDED TIME:TYPE OF OF INSPECTION: (�) SANITARY/LATERAL (PERMIT NO. 60-<2& ) ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE: f �" �— TIME: 6© — .eOOINSP: CONTRACTOR: WEATHER: WORK IN PROGRESS: < r 47 AREA OF CONCERN: SPECIAL INSTRUCTIONS: