HomeMy WebLinkAboutDrain Layers Permit 11 Hazel Street TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 6022
/4 — / , 19 93
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
// 11AZgn_ �21t_ at premises owned by 1)6ue 4 4/5 A Ski«y
whose address is i/ 14z.F4 a>;ZL dEZ:2l L.1i AJb Is M and tq
Lay House Drain, —Repair House Drain, Lay Main, Other ,
for .r/A]A/_C-- �tg4f 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 61, Pi/ _ i 7t'
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
Are..
,r�fJZ�L :D1L
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date / 93 Estimated Time for Completion
Permit to .be issued to "ThYti wRL lr��z �S�c//'S SE�'77C. 5e�lZr�iC�
the holder of Drain Layer's License No. „9orj7_,1S-' 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. 4 and/or
CHD Permit No. f .
Signed
Li ensed Drain Layer
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
/4W,
Engineering Dept. Date
Permit Fee Paid � .Ziy$ Check Number.
Connection Charge Receipt No. 3�o'fj Dated
Issued by1r�
INSPECTION Q
Date' work started - f 3 Date completed9
Sufficient notification r'e'c'e`ly—ea - //T Yes No
Special Conditions
AP P ool
Inspe for Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: \G \\\c\� TIME: / `-act p"-\
BY: �ot�� �`1 J �fl``�� FOR LOCATION:
DAY INSPEC. NEEDED �����\� TIME:
TYPE OF INSPECTION:
( V ) SANITARY/LATERAL (PERMIT NO. C>do�o ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: le,eld INSP:
CONTRACTOR: ( WEATH
WORK IN PROG ESS:
0
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: