HomeMy WebLinkAboutDrain Layers Permit 51 Heatherwood Drive .. . c- .
Y TOWN OF SOUTH WINDSOR
49
DEPARTMENT OF PUBLIC WORKS
i BUREAU OF POLLUTION CONTROL
,f
DRAIN LAYER'S PERMIT 6272
19
Pursuant to writtenapplication, permission is hereby granted to the
Lice sed pra 'kip
Layer nam d herein to perform the work indicated below t
J5/ r Atj D HC at premis s owned by J yyl G
whose address is 6S a a o -
Lay House Dra n, Repair H se Drain, Lay Main, Other ,
for tC occupancy or use, with 511
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 furnish two (2) copies of separate drawings.
OSHA REQUIREMENTS-.MUST -B -F LLOWED -
SPECIAL CONDITIONS t G w
Desired Starting Date Estimated Time for Completion
Permit to be issued to Jar JG� GGtl.?� S
the holder of Drain Layer ' s License No . 2.Og�30 . Permit will expire thirty
( 30) days after date of issuance. The unde-rsigned 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 .
SignedAidlicense
ice'ns Dra ' Layer
The above named Drain La er hae a val issue by the State of
Connecticut and . has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor :
r3 // -z7 3 y'
Engineering Dept . Date
Permit Fee 'aid $ r' 00 Cheek Number K (` e"A. TV, , gSq,S
Connection Charge Receipt No . Dated
Issued by
INSPECTION {}`
Date work started '��'— gjr� iDate completed cy'd�
Sufficient notification receive es No
Special Conditions
�r� Y APPROVED: /� U<
- - - Inspector Date
SANITARY LATERAL. & EXCAVATION PERMIT
INSPECTION REQUEST
DATE. OF ;AEQUEST'i 7" g S TIME
`. BY: f d � ,fib-GCS(J�-f FOR LOCATION:O/�A—.Y)'T/�' g;::. �'r�}.,�
s}" DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
_. . ( sA�NITARYt ATE ;, {-11E = Na. G�Z7Zi ) (Qe ) FOOTING-,.DRA.IN.,
! ( ) EX-CAVATION (PERMIT NO. — ) ( } OTHER
i
INSPECTION, REPORT,,.
DATE.: y TIME: /202'? INS P
r�
CONTRACTOR:
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: