HomeMy WebLinkAboutDrain Layers Permit 400 Governors Highwa TOWN OF SOUTH WI N DSOR
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DEPARTMENT OF PUBLIC WORKS
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BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT111121 6023
19
Pursuant to written application, permission is hereby granted to the
Li�Q�sed Drain La er :famed herein to perform the work indicated below at
6 (7 / ' Premises at remise owned b �I p VY ( ,
whose address is p/ , aj., r,T - a tq
Lay House Drain, Repair n se Drain, Lay Main, Other
for �' q�J� ccupancp or use, with -- -----
Family Units, wit , ,`L'S acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE { ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made witha'Sj t
Show sketch of proposed work or furnish 'two (2) copie-s of separate drawings.
.S
O/fSHA_ REQUIREMENTS MUST E OLLO
SPECIAL , CONDITIONS_ ; JA// ::�De—CS 4-o he �>t�
Desired Starting Date / Estimated Time for Completion
Permit to be issued to
Tr)h i,. D r,egt ) a) 1�1,l�'I 1 ,CoN sr7t-cJr ,�,✓
the holder of Drain Layer's L cerise No. 70g& 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.
Signeidli4cense
D in Layer
The above named Drain Layer has a va is ed by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
, name of the Town of South Windsor:
/0
r ineekl4g Dept. Date
Permit Fee Paid $ ZS rU U Check n mber
Connection Charge Receipt No. .4-36 1:� Dated !t?/�!'rl�
issued -
INSPECTION
Date work started Date completed
S-u-f-€i-c#ent notification ece es No
Special Conditions
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:
BY: FOR LOCATION: Q .
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( ) SANITARYMATERAL (PERMIT NO. �� ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
n INSPECTION REPORT
DATE: TIME: tell, 38 INSP: /IG
CONTRACTOR: -21 WEATHER: , Q
t WORK IN PROGRESS:
3r3o /1 Z - P*.5- &ET
F.
AREA OF CONCERN:
's
SPECIAL INSTRUCTIONS:
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: �� l ��`""� TIME: 3
BY: %�7y' �� e��3r FOR LOCATION: %�Av
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. ���—_� ) ( ) FOOTING DRAIN
( ) EXCAVATION {PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 16 — v
_ TIME: INSP:
CONTRACTOR: j' WEATHER:
WORK IN PROGRESS: ' —rA4&�f`, 1 1�C- I�_ P4 Zvi' `- '
Zc l 3ru � T IF—z1Jd✓
4'
AREA OF CONCERN:
f;
SPECIAL INSTRUCTIONS:
Y