HomeMy WebLinkAboutDrain Layers Permit 155 Greenwood Drive y TOWN OF SOUTH. WINDSOR
;. DEPARTMENT OF PUBLIC WORKS
' BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 Slit
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Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer ' arced herein . to perform the work indicated below at
cn.rl,n ( t at premises owned by' !�'-e.r)
whose address is
Lay Hou Dra n, and to
'�, 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 ( ) 0193
'
Connection will be made with /��
Show sk itch of proposed work or furnish 'two (2) copies of separate drawings.
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OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Staqting Date , .= U '17 Estima ed Time for Completion
PerVA
to be issued to X
the hoI of Drain Layer' s License No y d Permit will expire thirty
(30) days after date of issuance. The undersi$ned ,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. a.nd/or -
CHD Permit No.
Signed -
Licensed Drain Layer
The above named. Drain Layer has a valid license issued by t:he . State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
-s�
Engineering Dept. Date
Permit Fee Paid $ �i.'lf�"""� Check :Number
Connection Charge Receipt No. Dated ;;1__09;-�50f
by
INSPECTION
-Da-te work t a-r-t.e d - : . -- -Z'T-- -
Dafe comp feted
Sufficient notifica on receive es No
-- _._..
S-pedal Conditions
In ector Date
INSPECTION REQUEST
DATE OF REQUEST: 7 , TIME: �
BY: �Z 77,1"0,5v-W£- FOR LOCATION:
DAY INSPEC. NEEDED 122t TIME: ` �
TYPE OF INSPECTION: ff
( ) SANITARY/LATERAL (PERMIT NO. tr _) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 7-2- 7- TIME: ( INSP. Aczg�
CONTRACTOR: �j. sj tz WEATHER•
WORK IN PROGRESS: ff
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SPECIAL INSTRUCTIONS: