HomeMy WebLinkAboutDrain Layers Permit 61 Hazel Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �4P ' 6 2 9 1
k HJUAJ 19-2s
Pursuant to written application, permission is hereby granted to the
Licensed Drain L ye named herein to perform the work indf.ca ed elpot1c,
at
11Df at premises owned by ,Xe _ / r`-'
whose address is and to
Lay Hous Dra tl
Repair House Drain, Lay Main, Other
for I' ,�a 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 rj
Show sketch of proposed work or furnish t o (2) copies of separate drawings .
C�,Y 1039
C I
OSHA REQUIREM NTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date UA/ Estimat d Time for Completion
Permit to be issued to ,� (`Q
the holder of Drain Layer ' s License No. p 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 . and/or
CHD Permit No .
Signed
icensed Drain Layer
The above named Drain Layer has a val/dlicen�ise issued by the State of
Connecticut and . has filed a satisfactory bo d and insurance policy in the
name of the Town of South Windsor :
l D v Engineering Dept . Date
Permit Fee Paid $ Check Number 7
Connection Charge Receipt No . ��� • po Dated (Q i / 'Z , �90
Issued by
INSPECTION
Date work started 21 CI Date completed Z ®-- �S
Sufficient notification received es No
Special Cond do ,
APPROVED• a �,�, J
nspecto Date
SANITARY LATERAL.& EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: `' 19 - %S TIME:
BY: .FOR LOCATION:- � Ll �a
DAY. INSPEC.' NEEDED �= 9 TIME:
TYPE OF" INSPECTION
( } SANITARY/LATERAL` (PERMIT':N0. 2 9 } ( } FOOTING DRAIN
( } EXCAVATION.- , .` (PERMIT NO: ) ( ) OTHER
INSPECTIOWRIEP-ORT
DATE:i, y. TIME: D as INSP: 1�
CONTRACTOR,-- . P T�FEI�THER: 'Q °
WORK IN PROGRESS:
6-2 a - 9
55,
( 0�
AREA 0')? CONCERN:__Zl' `
_ _ h-, .
r p
SPECIAL INSTRUCTIONS: /O ! 4O A. 44
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