HomeMy WebLinkAboutDrain Layers Permit 980 Foster Street E ` TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6086
19
Pursuant to written application, permission is hereby granted to the
Licensed Drain 1Layer named herein to perform the work indicated below at 1
'990 4 E,,f at premises owned by .S'.�,i;,�,_
whose address is .pjxp rosin 5����+ L7,4• ,Sul_- , W111AC^_ and to
Lay House Drain., Repair House Drain, Lay Main, Other
for �s , I,_ Q'1 / 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 rV ith
Show sketch of proposed `work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date _ =3 - v)/ -S y Estimated Time for Completion N
Permit, to be issued to J�olc�le, ,10"4V,
the holder of Drain Layer's License No.Qob,440 _. 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' sAde
thee� `- licant has received Town Permit No, nd/qf
P
CAI .Per ` -
jr �r
a v = Signed
Licensed Dra n La er
`T e b e' named Drain Layer has a valid license issued b the y State of
natu $nd hag filed a satisfactory b nd and insurance policy in the
name, e. Town of South Windsor:
r 5 .o0 E inklIng Dept. Date
Permit Fee Paid $ Checr. umber '
Connection Charge Receipt No. L Dated
J- --- - _ Issued-b - ------
INSPECTION —
D-ate.--work started Nate completed
Sufficient notif ica on rece ve : -_No
Spec a Conditions
Inspector Date
1
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME: ,���rz•� '
BY:
j� UG �/G UE FOR LOCATION:-
DAY INSPEC. NEEDED 3� 1(9 TIME: r
TYPE OF INSPECTION:
( V ) SANITARY/LATERAL (PERMIT NO. 604y ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: -Z �/- % 3 'I TIME: i7fi�'> INSP: �/,
CONTRACTOR: WEATHER:
WORK IN PROGRESS: ,l� 2Z1Z--`
6z,/v�7,�� G�rvc �l l �/�-5 /aC'' ✓/'G��� � >z�
r
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: