HomeMy WebLinkAboutDrain Layers Permit 180 Greenwood Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5 4 81
19
Pursuant to written application, permission is hergby granted to the L'cerned, D in Layer
named herein to perform the o k indicated b ow at
at pre ise owned by -to F r'U
l Q �•�, r � whose address is
and to
Lay House Drain, Repair House- a.in, Lay Mein, Other__
for occupancy or.`dse ,nth T
Family Units, with acres. 7
,t
Type of Sewage to be connected under this permit: SANITARY SEWAGE of), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copieslof"separate drawings.
SPECIAL CONDITIONS
Desired Starting Date zi D Estimated Time for CompletionUA
Permit to be issued to �OW1
the holder of Drain Layer's License No. )_0 Permit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer he bey grees to all the terms and
conditions set forth in the permit and the reverse side ther p lic t has received
Town Permit No. and/or CHD Permit No.
i
Signed \
Licensed Drain L yer
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:
Engineering Department Date
Connection ' har a Paid (lJ0? r'� �Gr
g Permit Fee: Paid $ �.�•pU
41, Check Number OI�
Issued by
Tax Office -
- -
INSPECTION
Date work started Date comple ed Z 0
-----Suf€- a-ien-t not if ica-tion--rec-eive-d-: -- Yes -
Special Conditions
APPROV -
Inspector Date
TOWN OF SOUTH WINDSOR r
SANITARY SEWER LATERAL FI EL D LOCATION
S
DATE OF CONSTRUCTION: 1? o
BUILDING ADDRESS OR LOT N': L07- �� '
STREET:
SUBDIVISION: _Mne)rviA_ lnJ ILA
bH STATION : +
NORTH ARROW INVERT ELEV: s 5
TIE TEE
iOf-�!1 FT FT.
HOUSE LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. FT
(IF EXIST.) BUILDING
- (IF EXIST.)
TIE TIE
NH STATION : +
INVERT ELEV:
-iArei--0, W;�3�EU--
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
JF 2-2-
STREET ADDRESS SIGNATURE DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
-- 3 ) (5f` �{ 45
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER