HomeMy WebLinkAboutDrain Layers Permit 170 Hillside Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 6293
19.9.5
Pursuant to written appliea.tion, permission s hereby granted to the
Licensed D in La-yertnamed herein to perform the work- ind ca ed 'below at
lit'sI A at premises _ owned by
whose address is and to
Lay Ho a D 'ai , 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 ( )
Connection will 'be made with _1 l
Show ske ch of proposed work 'or fyixxu, sh two (2) copies of separate drawings .
C:8prof r
,
t
SHA REQUIREMENTS MU,S BE FOLL ED
SPECIAL CONDITIONS
, 5(
-. _s
I Desired Itarting Date Estimateir Time f r Comp etion
CP 0 to W6� 5
Permit to be issued tocat�►K.S
the holder of Drain Layer ' s License No. . 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
LicensXT Drain Layer
The above named Drain Layer has a vali 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 :
049 Engineering ept . Date
Permit Fee Paid $ S, OQ Check Number
C-onnection Charge Receipt No. ®p Dated ty /9F5
17/,3 Issued by 4C11 `
INSPECTION —
Date work started Date completed ` Z 2
Sufficient notification r cei" ea ---yes No '
Special Conditions �
APPROVED ` a Z qS
- - - ns-a c--t�o_r - - D a—t e-
SANITARY LATERAL &_ EXCAVATION PERMIT
INSPECTION REQUEST
i DATE OF REQUEST: �- Z�j _ 95 TIME: �: O
BY --�-- '� FOR LOCATION: 170
} > .DAY INU SPEC NEEDED 93, TIME
i. TYPE-OF INSPECTION:
SANITARY LATERAL:c PERMIT NQ� �A� ) (. )
( ) t 6 F00.TING,.IlRAlN..
{ ( j EXICAVATION (PERMIT NO ) ( ) OTHER:
INSPECTIOWREPORTr.
DATE:- `"yZ- _- �°� TIME: 00 NSP:kj ez
CONTRACTQR s 'n.,,.. z WEATHER-:- a L c7 5 °r y--
WORK IN- PROGRESS 14
AREA OF CONCERN: _,4411-12
SPECIAL INSTRUCTIONS: 7'�io& p •
21
��� l�l� S
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
GATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' :
i
STREET: —mid t
AAi STATION : + ''
NORTH ARROW INVERT ELEV: 5
�. TIE TIE
`u
FT. FT.
3
HOUSE LATERALv LATERAL HOUSE
CONNECTION TUB STUB CONNECTION
FT. FT,
BUILDING INV. ELEV. INV.ELEV. t= INV. ELEV. INV. ELEV.
LL BUILDING 1
(IF EXIST.) (IF EXIST.)
TIE TIE
QM STATION : +
k VIfls
INVERTELEV:
CONTRACTOR (PRINT) NAM OF CONTRACTO 'S SUPERVISOR(PRINT)
�agl� /2
STREET ADDRE S SlldNAfURE DATE
_J
( yT1
TOWN STATE ZIP INSPECTED BY TOWN DATE
) aliq
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER