HomeMy WebLinkAboutDrain Layers Permit 1546 John Fitch Boul • . TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 6052
November 22 1993
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer namedherein to perform the work indicated below at
1546 John Fitch Boulevard at premises owned by Donald Baltulonis
whose address is Bra a rae and to
Lay House Drain, V. Repair House Drain, Lay Main, Other
for ro �.r- C, GL a occupancy or use, with � �
Family .Units, _with 1 02 acres.
a
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 'twb (-2) copies of separate drawings.
OS7� REQUT ENTS T B FO LOWE
-- ----SP-ECIAL- CONDITIONS—
DesiredStarting Date f Estimated Time for Completion, f
Permit: to be issued tor'r��'�
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. i
Signed
Licensed, Drain ,Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory bond and:,insu ance' policy in the
name of the Town of South Windsor:
_1z1�
ngi(n ing Dept. Date
Permit Fee Paid $ ,00 Ch�.IE Number 1�::� 6C�
Connection Charge Receipt No, Pited 1 \fix
Issued by
r
INSPECTION y�
Date work started /Z-2 - 9,3 ,"Date comp Leted
Sufficient notification re�pelveal V y e`s No"'
Special Co ditions
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:_ 2 : P�nN
r _
BY: \ \- FOR LOCATION:
DAY IN EC. NEEDED �o<< ;c�C �� TIME: 3c,
TYPE OF INSPECTION:
SANITARY/LATERAL (PERMIT NO. C��,`5��, ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( } OTHER
INSPECTION REPORT
DATE: TIME: �cP� INSP: h�
CONTRACTOR: WEATHER: ]
WORK IN PROGRESS:
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AREA OF CONCERN:
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SPECIAL INSTRUCTIONS: