HomeMy WebLinkAboutDrain Layers Permit 141 Graham Road (2) TOWN OF SOUTH WI'NDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL.DRAIN LAYER'S PERMIT a stG 5775
Sam i9
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named Oerein to perform the work indicated �elow t
o I� AV at premises owned by /W1 le ,�tw �
whose address is o Bu 0,,P4en I-- AV
Alto
Lay House Drain, Repair House Drain, Lay Main, Other ,
for / 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
Show sketch of proposed work gr furnish two (2) copies of separate drawings.
d 'F G'
SPECIAL CONDITIONS
Desired Starting Date s Estimated Time for Completion
Permit to be issued tocn�l�
the holder of Drain Layer ' s License No. aoF3S7 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 To Permit No . and/or
CHD Permit No.
Signed _
.4r z
License rain Layer
The above named Drain Layer has a valid .license issued by the State of
Connecticut and has €-iled a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
gi eering Dept. Date
Permit Fee Paid $ 2� 00 Chuck mber
Connection Charge Receipt No. 14171_ Dated .4
INSPECTION
Date work started Z- } '` Date completed_- 2 �Z
-S-uf f-i-elent notificaiont retie- ve : - es- No - -
Special Conditions
AP VED: n 6•
spector Date
- - - - _ 7I
y TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: /
BUILDING ADDRESS OR LOT N' : j '�/ G.C�h�,,, ��Q •Co
STREET:
SUBDIVISION:
MA STATION : +
NORTH ARROW INVERT ELEV:
�C.
KlNl
> x
TIE TIE
FT FT
HOUSE LATERALr LATERAL _ HOUSE
CONNECTION STUB STUB CONNECTION
FT. FT.
BUILDING INV. ELEV. INV.ELEV. INVU. . ELEV. INV. ELEV. BUILDING
(IF EXIST.) (IF EXIST.)
_ 1
Q TIE TIE
Mi STATION
INVERT ELEV:
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
STREET.ADDRESS SIGNATURE AT
_ e<' O60,�-2
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER