HomeMy WebLinkAboutDrain Layers Permit 198 Kent Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5536
I 0 L&,� i- /S , 199/
Pursuant to written application, permission is hereby ranted to the Licensed Drain Layer
named herein to perform the work/�indicated below at LC /�Ft�f a
at premises owned by to ro,»4, whose address is
and to
fi Lay House Drain, Repair House Drain, Lay Main, Other ,
for / uK,r L, occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE V'�, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
U ip
/ i
Show sketch of proposed work or furnish two (2) copies of separate drawings.
I(G ( j I ays e !.-ui 4-4
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a
SPECIAL CONDITIONS
Desired Starting Date A SA P Estimated Time for Completion
Permit to be issued to JAy, Li LC t11 a-,-4ak. ( f o(a.29
the holder of Drain Layer's License No.C2041K rmit will expirk 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
L c nsed Drain Layer
The above named Drain Layer has a valid license iss d by t e State of Connecticut and
has filed a satisfactory bond and insurance policy in the name o the Town of South Windsor:
�4 �/�5 w
I
Engineering Department ! Date
Connection Charge Paid o Permit Fee: Paid $ oZ�
Check Number y5[�
Issued by
Tax Office
i
INSPECTION �(� �(
Date work started -`2- Date completed 2-"1- -9 f �'
Sufficient notification received: Yes No
Special Conditions 1001, i-
APPROVED:
Inspector Date t°
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FI,,EL D LOCATION y
DATE C :CONSTRUCTION:
�y
BUILDING ADDRESS OR LOT N° : , o�l Re4L7 — /_A4,
` a STREET:
SUBDIVISION: ;
�=G1
AM STATION : +
NORTH ARROW INVERT ELEV:
"L� e
t . TIE TIE
�FT. FT.
HOUSE LATERAL LATERAL HOUSE
CONNECTION STUBf� STUB CONNECTION
FT. - �%1 '"° �' T1
t� FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST) (IF EXIST.)
C�
TIE TIE
NH STATION : +
INVERT ELEV:
ONTRACTOR (Phi T) N OF CONTRACTORS SUP SOR(PRINT)
STREET ADDRESS SIGNATU E DATE
TOWN--- STATE zip( INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR # YELLOW -CONSULT'ING:ENGINEER/DEVELOPER