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HomeMy WebLinkAboutDrain Layers Permit 10 Gardinia Lane TOWN OF SOUTH Wl N DSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT NO -?cc m 19 9 Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated below at �,©_k #ND at premises owned by _Rs-aOYY\ .t IA whose address is 2,0-7 (,Je_s4 " Rr, C,4- and to Lay House Drain, Repair House Drain, Lay Main, OthevSz _ v- , for n 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 6,0 Spy` S, Show sketch of proposed work or furnish two (2) copies of separate drawings . SPECIAL CONDITIONS Desired Starting Date Estimated Time for Completion Permit to be issued to � �-��� � ,� , o C1. the holder of Drain Layer ' s License No . 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 side thereof . Applicant has received Town Permit No . and/or CHD Permit No . Signed Licensed D ain 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 : En neering Dept . Date Permit Fee Paid $ fR5 .00 Check Num er 0a15gq Connection Charge Receipt No . 2 Dated Issued by /r �/7 INSPECTION Date work started 1-3 92 Date completed 1- /5-9 2 Sufficient notifica--ion re eive : yes No Special Conditions APPROVED Inspector Date TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS OR LOT N2 : :t�t10 STREET: 60ARflEgvi� L-I'TNE SUBDIVISION: VE"B(LbpKt NH STATION : jq +.� NORTH ARROW INVERT ELEV: �o• TIE t TIE FT / -FT. _. Z HOUSE _ LATERAL LATERAL HOUSE CONNECTION STUB STUB CONNECTION FT. I /.ZZ FT. BUILDING INV. ELEV. INV.ELEV.: INV. ELEV. INV. ELEV. (IUILDING F EXIST.) "�3.47oR� accfc (IF EXIST) '7 .6 FooT►tI6 ►x1V.MiT' TIE �1d1 TIE l Q,-17049-xo, J' STR. Iz+Bo f,-r NH STATION ; 3 +..L_ � ROTIJ►4, 10, IIV=125.-(0� Lo r[v'.o"101ZS•2g INVERTELEV: AIAM Fx�T�IoNCOkR,N GL.E,vN Reco z 'Ko&e� .Jm+ E 41 fff�r0Z'Z -. Q� r>LAILO6�5 CONTRACTOR (PRINT) NAM OF CONTRACTORS SUPERVISOR(PRINT) 5AIN1- Mh " CXCLE 176 ChgZunIE ri �' - p-ZS-`} 1 STREET,ADDRESS E DATE TOWN STA E ZIP INSPECTED BY TOWN DATE �rzs`32.3 g5' - I TELEPHONE NUMBER WHITE - TOWN PINK — CONTRACTOR YELLOW —CONSULTING ENGINEER/DEVELOPER