HomeMy WebLinkAboutDrain Layers Permit 423 Felt Road TOWN OF SOUTH W!N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 6298
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
at premises owned by
whose address is and to
Lay House Drain, epair House Drain, Lay Main, Other ,
for occupancy or use , with
Family Units , with acres .
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR
f 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 `— stimated Time for Completion
Permit to be issued toJ �. ✓ G
the holder of Drain Layer' s License No;. .ZPermit 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
L 1 cen;sd
Dra 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:
Cl
Engineering Dept. Date
Permit Fee Paid $ Check: Number y
Connection Charge Receipt No. f Dated —/Z--•
Issued by
INSPECTION
_Date work started Date completed
Sufficient' notificarlon 'rece ve . es No T---
Special Conditions
APPROVE
n Is;pector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
E DATE: OF 'REQUEST: f ' ��—�,�� TIME:
BY: ��C_ FOR LOCATION:
DAY INSPEC. NEEDED TIME: 0 3C�
TYPE`-`OF INSPECTION
(� ) SILNITARVLATERAL ('PERMIT NQ`: ?i ) ( }, FOOTING 'DRAIL3•
+ ± ( ) EXCAVATION" . (PERMIT NO. } ( ) OTHER . ,
INSPECTIONS REPOR
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DATE, TIME: INSP:
9A x"
CONTRACTOR e= WEATHR`:
WORK IN> PROC:RESS ,
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of
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: