HomeMy WebLinkAboutDrain Layers Permit 28 Grandview Terrace TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
s9 DRAIN LAYER'S PERMIT N 2 6059
of g dl.(1 I QLC DenAmher , 19 93
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
r.nt 6 rrav%Avv4o, W tates at premises owned by RSK Kellco
whose address is _ 17BO Ellincrton Road, South Wtndsor, CT 06074
Lay House Drain, X _Repair House Drain, Lay Main, Other and to
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 -
or furnis two (2) copies of separate drawings
,l '.�.'
cc111uecr tangy
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date Z- U9- Estimated Time for Completion
Permit to be issued to /�,S jL �- X/c,
the holder of Drain Layer's License No. c
�7?`f1 Permit :will expire thirty
{30) days after date of issuance. The undersigned Drain Layer hereby agrees
to all the terms and conditions. set . fort"n the permit and the reverse side
thereof. Applicant has received Town Permi No.
CHD "Permit No. -ar
Signed
�/� L ensed Drain Layer
- The above named Drain Layer has a `Talid license issued by the State of
Connecticut and has filed a satisfactor bo d and i ranee policy in the
name of the Town:"of South Windsor f
n inee Dept . Date
Permit Fee Paid $_ ,��'_ QO Che k umber ` �Q
Connection Charge Receipt No. Dated 4
t
Issued by /1
INSPECTION
Date work started / Z 9 1P Date -completed Su-f-ficient notification rece1Ve • _ yes No
Special Conditions
. APPROVED•
Inspector Date
Z~41 IHKY LA1 LKAL & LAL;AVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: /'2. - `/� TIME:
d O �l ✓v1 a
BY: e FOR LOCATION: n 6 J
DAY INSPEC. NEEDED Z - Y q 3 TIME: ;
TYPE OF INSPECTION:
SANITARYMATERAL (PERMIT NO. Q ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
- DATE: 7- TIME: crINSP:AiL7,2aZ
CONTRACTOR: € ff WEATHER: c
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: