HomeMy WebLinkAboutDrain Layers Permit 48 Judge Lane 77
TOWN OF SOUTH WINDSOR �� y
DEPARTMENT OF PUBLIC WORKS
` BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6092
12 Pursuant to written `"I)c�.(�Q . 19
� ' cation, permission s hereby granted to the
L ' ens�d Dr in La �erna a herein to� perform the work indicated el w at
t��at premises owned by �L� �,� fol
whose address is
Lay House Drain °fnG s and to
. l=-- Repair House Drain, Lay Main, Other
for occupancy r use, with
Family Units, with acres,
Type of Sewage to
e connected under this permit : SANITARY SEWAGE (
INDUSTRIAL WASTES ( ) OR ( )
Connection will be made with 3
Show sketch of proposed work or furnish two 2
( ) c of separate drawings.
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date Zl- Estimated Time for Completion ' >Z�y-
Permit- to be issued to
the holder of Drain Layer's License No.
Permit will expire thirty
(3D.) -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.
CHD Permit No. and/or
SignedIle
f ".
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 insurance policy in the
name of the Town of South ,Windsor:
3&11171�
n inee i Dept. - Dat.e
Permit Fee Paid $ 2�-U U Check umber
Connection Charge Receipt No. a¢ z
D ted 3//(�
Issued by 3 2
INSPECTION
Date work started q 7- - 9 Date completed Sufficient notifica— on rece ve :Z ��' 1-- - ,
Special Conditions ---- e8 No
Inspector Date
--- -
r SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 3!Z� f g TIME:
BY: `�'�v \ � � FOR LOCATION:
DAY INSPEC. NEEDED Z L�� TIME: 1442�-�-.�
TYPES OF INSPECTION: / Q
( V ) SANITARY/LATERAL (PERMIT NO. (6 < Z ) { ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 9 " Z. TIME• �.r� � INSP• Cc. Ar�G
CONTRACTOR: WEATHER.:
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: