HomeMy WebLinkAboutDrain Layers Permit 18 Heatherwood Drive TOWN OF SOUTH WIN DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
Cr DRAIN LAYER'S PERMIT
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Pursuant to written application, permission is hereby granted to the
Lice ;gd 671 Drain Layer roamed herein to perform the work ind cated below t
eat p emise owned b
whose address s 6 s - �_a to .
Lay House Drai` Repair use D ain, Lay Main, Othe '
for r f , occupancy or use, with
Family Units ith 13Zar acre
Type of` Sewage to be connected under this permit SANITARY SEWAGE
INDUSTRIAL WASTES ( ),,. OR, :(
Connection will be (made with <
at
Show sketch of• proposed work or furnish 'two (2) copies of separate drawings.
f
OSHA REQUTREM
SPECIAL CONDITIONS T MUST BE F LLOWED
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Desired Starting Date . // Estimated Time for Completion
Permit to be issued 'to c ":i7 510ep3
the holder of Drain Layer' s License No. "7�Je6g'3'p. Permit will 'exptethirty
(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. reu.e;rse side.
thereof. Applicant has received• Town Permit No. and/or.
CHD Permit No
Signed :.
It�6:n;sfd Drain Layer .
The move named Drain Layer has a valid licep issued .by. ,the State of .
Connecticut and has filed a satisfactory bond andrinsurance policy -in, the
name of the Town of South Windsor: V -
Engineering Dept.. Date. .
Permit Fee Paid $ tP Check Number316
Connection Charge Receipt No. ,$p Dat-ed
Issued .b y
r
INSPECTION
Date work started Date completed Z1,
Sufficient notificat own received: Yes No
+ Special Conditions
AP P ROI_=�
Inspector Date of
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SANITARY LATERAL & EXCAVATION PERMIT
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INSPECTION REQUEST
DATE OF REQUEST: �� - �7_ / TIME: 2 ; �O q
BY: FOR LOCATION:& --Air
DAY INSPEC. NEEDED ll r �U f TIME: �, 4 .
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT NO. Z I } ( ) FOOTING DRAIN
( } EXCAVATION (PERMIT NO. ) ( } OTHER
INSPECTION REPORT
DATE: / /� /�j } TIME: 9`Do [� .,ti1� INSP:
CONTRACTOR: WEATHER: �}
WORK IN PROGRESS: 'A Zal
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: