HomeMy WebLinkAboutDrain Layers Permit 505 Foster Road TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6012
505 E� '040%�
FD34e r Road 19
Pursuant to written application, permission is hereby granted to the Licaed Dra n L y r named herein to perform the work indic ed be w
-�-L- 'n c �'� at remis s owned by Gj6 /7t
whose address is ® er-
Lay Rouse xain Repair House Drain, Lay Main, Other and to
for i occupancy or use, with
Family Units, with / acres.
Type of Sewage to be con ected under this permit: SANITARY SEWAGE !�j),
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
. Show sketch_ of proposed1work or 'furnish "tw {2 copies of separate drawings.
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REQUIREMENTS MUST BE FO LO ED ,
SPECIAL CONDITIONS !
Desired Stafting Date Estimated Time for Completion
Permit to be issued to - ^w
the holder of Drain Layer's License No. �vl
Permit will expire thirty
(30) days after date of issuance. The un ersigned 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
Licen ed Drain Layer
The above named Drain Layer has a val license issued by the State of
Connectihut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
Engineering Dept. Date
Permit Fee Paid $ �',Qo Check Number ,
Connection Charge Receipt No, d�- ifAl 5-1 Dated
awed by _ y
INSPECTION
a e work _ started 9- - Date completed Yes- 9�g-
Sufficient- notifica a e6-e , � .
- - --- _ � . _
Special Conditions '
APpROVE 70
.��
nspector Da
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:
BY: �� tU�y�_ FOR LOCATION:
DAY INSPEC. NEEDED Q��\gam TIME:
TYPE OF INSPECTION:
( VI) SANITARY/LATERAL (PERMIT NO. l' 01, ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: �- �} - �3 TIME: 60 — -�.d INSP:
CONTRACTOR: 7 WEATHER: 7(!!� ® fi
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: