HomeMy WebLinkAboutDrain Layers Permit 1445 Main Street TOWN OF SOUTH--WI NOSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
NmtA7Zt1-S7PERMI
ILA cJ / 19
Pursuant to written application, permission is hereby granted to the
Licensed Drain La er name erein to perform the work indicate below at
,�7 J� 1�/ � at premises owned by Lc r- /I2?irys lv-✓
whose address is _ Ji_t yy� & • t and t
Lay House Drain, —Repair House Drain, Lay Main, Other
for � .4,tv,T,V occupancy or use, with
Family Units, with _acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
i Show [etch of proposed work or fur sh 't o 2) copies of separate drawings.
ST
SPECIAL CONDITIONS OBE FOLLOWED
Desired Starting Date S Estimated TIme for Completion „
Permit to be issued to `w y
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. .
Signed -`✓
L e ed raiff� ayer
The above named Drain Layer has a valid license issu 'by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
E gineerng Dept. Date
Permit Fee Paid $ , 00 Check NumberaZ
Connection Charge Receipt No. Dated
Issued by
INSPECTION
Date work. started. 2 —� Date completed
Sufficient notif ic'at n race ve—tc '. es No
Special Conditions
APPROVED /5,'X15 .
Inspector Date
' SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: I I �-9 5 TIME: t S
BY: d2 de�e2 ( FOR LOCATION:
DAY INSPEC. NEEDED /4- TIME:
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE:. IL /S'% .,3 TIME: INSP:
CONTRACTOR: �.�sp� �1 WEATHER:
WORK IN PROGRESS:
4ZZ ied
r
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: v\, _ �\ TIME: 3
BY: c FOR LOCATION:
DAY INSPEC. NEEDED \\\��' TIME:
TYPE OF INSPECTION:
( � ) SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: