HomeMy WebLinkAboutDrain Layers Permit 209 Felt Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5724
3 197z
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
2-09 FELT T 7 at premises owned by C1A;tA4 &A% L/ e7L/Ud7LE
whose address is 4O9 Z_p S. cu/ND. and to
Lay House Drain, <Repair House Drain, Lay Main, Other ,
for S/NGLE F oU l� I/ 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 6n 11 ;p✓G
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date 3 Zs 9z Estimated Time for Completion 3 ,7G 9�
Permit to be issued to
the holder of Drain Layer' s License No. p .. Permit will expire thirty ,:
(30) days after date of issuance. The undersigned Drain Layer hereby agrees
to all the terns and .conditions suet forth in the permit and the reverse side
thereof. Applicant has received Town Permit No. nd/or ,
CHD Permit No. ,
Signed
Licensed Drain 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 :
cC �'
En6fineering Dept. Date
Permit Fee Paid $ 2 6,v v Check Number 5�6
Connection Charge Receipt No. Dated /2LJ C12
Issued by
INSPECTION
Date work started E— 92 Date completed
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Special Conditions
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AP PRO VE .< Z
Inspector Da't
q.
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TOWN OF SOUTH WINDSOR �° _ 820
BOND -
FA
Re PUBLIC WORKS DEPARTIKENT /` ..
q• Date ¢ I Z.-
• TOWN HALLon File 1540 SULLIVAN AVENUE Permit No.
SOUTH WINDSOR, CT 06074
Date of Expiration Permit Expires
APPLICATION FOR PERMIT
FEE
Name and address of applicant ,SK—I'PS, �&IrPTICg-�ELLING. Phone No.
Location of proposed work 20-9 FELT P-..9ADi �,50UTH WIND,
Describe fully nature of permit requested CONNECT.-EXISTING.
; EJWER LATERAL=
Insurance on file with Town yes no Date policy expires
Name of Insurer
oApproximate time for completion Desired starting date
d Call before you dig ticket 14o. f
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aShow sketch of proposed work or furnish 2 copies of separate drawings
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y
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a Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
Q
I agree to furnish to the Town of South Windsor the amount of bond or deposit required and to
reimburse the Town of South Windsor for any expenses incurred by the Town for maintenance or repair
work in connection with this permit and that I am familiar with and will abide by the rules and
regulations for permits as outlined in the Town of South Windsor's (Pavement Cut Regulations.)
Signed _
APPROVED: DATE APPROVED: DATE`?
Supt. of Highways Town Engineer
• FOR INSPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: Perm. Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector