HomeMy WebLinkAboutDrain Layers Permit 25 Jared Court r -
TOWN OF SOUTH WINDSOR
C. DEPARTMENT OF PUBLIC WORKS
f BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6088
Q
3 w 19
Pu sAfan Jo �fit.f'.p application, , permission is hereby granted to the
Licens d`" Dr n Layer Et`e "a 'to Perform the work indicated below at,
�O t r mis`es owned b
P Y 1h T
whose addres is S d to
Lay House Drr in, Repair Ho se Drain, Lay Main, Other ,
for / occupancy or use, with TIA-7 �
Family Unit' , with 3 acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ( ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with 35" 5f ,CjL ;--.91/J7
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA AEQUIR E TS MUSS''SSE FOLL ED
SPECIAL CONDITIONS - <-- � �7 �r— -- - - ----- - -- - - -
2 S.
Desired Starting Date •-Z/ ..Estima'ted, Tl for Completion rJ "
Permit. to be issued to
the holder of Drain Layer's L cense 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. f.
Signed
/// L"ice/ a Drag#" Layer
The above named Drain Layer has a vaYid 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: �J
OnoineeQ4 Dept. Date
Permit Fee Paid $ _7aW _) Check \ mber lzi4-�
Connection Charge Receipt No. Dated
Issued by
INSPECTION
Date work started Date completed 1-_4 °9
d
Sufficient notification eceive : _ es No -
Special. Conditions
- APPROVED: r _
I Spector Date /'
Y
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: y`'�1�` , T TIME: 6
BY: ��� ��a`,�eg FOR LOCATION: L.cr4JJrireQ �c-
DAY INSPEC. NEEDED y��1�gV TIME:
TYPE OF INSPECTION:
( ✓ SANITARY/LATERAL (PERMIT NO.6 O FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 4. - + - 9 4- TIME: Q Q INSP:
CONTRACTOR: WEATHER: Clg
WORK IN PROGRESS:
27
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: