HomeMy WebLinkAboutDrain Layers Permit 1 Karen Way TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL`'
/- � f DRAIN LAYER'S PERMIT 142 613 9
6G xzn 19
Pursuant to written applicati n, permission is herebyranted to. g the
Licensed Drain Layer named herein to perform the work indicated below at
at premises owned by
whose address is 7101,
�1'dP
Lay House Drain, �t/ Repair House Drain, Lay Main, . Other . and to
for oc -vpancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY
INDUSTRIAL WASTES ( ); OR ( ) SEWAGE ( ,
Connection will be made with W/
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
SPECLAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired- Starting Date Estimated Time for Completion
Permit to be issued' to
the holder of Drain Layer's License No. �L . 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 . ApplicanP-~has received Town Permit No. and/
CHD Permit No.
Signed
L censed. Drain Layer
The above named Drain Layer has- a valid l cense issued by the State of
Connecticut and has filed a satisfactory bond and insurance Policy in .the
name of the Town of South Windsor :
lam- �4 .
En ni eer n g g Dept. Date
Permit Fee Paid $ 2S•M Check -Number CAS
Connection Charge Receipt No. u(t- 1 Dated Q2dgk f
Issued by
INSPECTION
Date work started t/p—Z2 -�l`f Date completed
Sufficient notification received : es No
Special Conditions
APPROVED: -- - -
Inspector . Date
M '
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST _ ���I 1 C� TIME:_
BY: � �qn�� FOR LOCATION:
DAY INSPEC. NEEDED �L���Q.C� TIME: Q
TYPE OF INSPECTION:
( A( } SANITARY/LATERAL (PERMIT NO. (p/ ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE:- -Zz </ TIME• /D ' INSP
CONTRACTOR:_ WEATHER:
WORK IN PROGRESS:__
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: