HomeMy WebLinkAboutDrain Layers Permit 33 Fairview Drive (2) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS -
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6179
9 , 19 c
Pursuant to written application, permission is hereb gran ed to the
Licensed Drain Layer named h .rein to perform the work indicated below at
_ 12 Eni <IJ11E at premises owned by 4.1-19UP"FAY,�rNVV�
whose address is I exV k.� and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for occupancy or use, with -/ �C'' i
Family Units, with acres.
Type of Sewage to be connected under this permit : - SANITARY SEWAGE (/
INDUSTRIAL WASTES '( ) , OR ( )
Connection will bemade with ��, >> [y,
Show sketch of proposed work or furnish "two (2) copies of separate drawings.
OSHA RPIREMIENTS MUST BE FOLLOWED
SPECIAL CONDITIONS'
Desired Starting Date - — Estimated Time for Completion
Permit to be issued to r
the holder of Drain Layer' s License- No, aa7qS{, Permit will expire thirty
(30) days after dateof 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
is t
need Dra n Tayer .,
The above named Drain: Layer has a valid .license sue by th_e. Sta-te of
Connecticut and ha's -filed a satisfactory bon and ins ce policy . n' the
name of :the Town of South Windsor:
E g veer Dept. Date
f
Permit Fee Paid $ S•dU Check -N ber, 110U0 ,
Connection Charge Receipt. No. ` Da edq�
Issued by /
INSPECTION
Date work started 9 _ �- Date completed 1 9
Su r-ece3'vea "y'es No
Special "Conditions
- 'APPROVED,;." /�-
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 9- / 3- 94 TIME:
BY:— IA- 7
'�
.E. FOR LOCATION: 3 3
DAY INSPEC. NEEDED ) 9 TIME:_
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT NO. 6/ 7 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: C TIME: `C INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS ja.4
:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: