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HomeMy WebLinkAboutDrain Layers Permit 1742 Main Street ...•n--.— . .:.,:.,.,,g.. ..,.. . .� ;fir;"'. _•.'sue-ct*e9s;.Y�� `�'$'.�;� �.:$j;s�}'$a';:r;: �"`�.<Tit(';'�n°m.;�.t�''i¢"x:• x� '^z"..;'',s;:,:i . .:-' , z '- - - r TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL 6222 Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named _herein to perform the ; work. indicated below at Za2— 1tl _4 at premises..owned by whose dress is o #,&&) ,'-a and to Lay House Drain, Repair House Drain,�_Lay Main, Other for g/ 6 — occupancy or use, with Family Units , with r. acres . Type of Sewage to be connected under this permit : SANITARY SEWAGE INDUSTRIAL WASTM ( ) , OR ( ) • Connection will be made with , - Show sketch of proposed work or furnish two (2) copies of' separate drawings . 'OSHA REQUIREMENTS MUST BE FOLLOWED SPECIAL CONDITIONS Desired Starting Date Estimated Time for Completion Per:%i.t to be issued to the holder of Drain Layer ' s License No. Q49 Permit will expire thirty' ( 30) days after date of issuance. , The undersigned Drain Layer hereby_ agrees to all t' e terms and conditions set` forth in the permit and the reverse side thereof . Applicant has received Town Permit No, andjor r ZHD Permit :No , Signed Licensed Drain Layer w. The above named Drain Layer has a valid license issued by the State of C-onnec.ticut acid . has filed a ,satisfactory bond and >ifisurance .polity in the na>me of the Tfown of South Windsor; IF Z Engineering Dept . Date Permit Fee Paid $ Check Number Connection Charge Receipt No. L/ D. ted / Issued by - o INSPECTION Date work startedi Date completed /Z 2 9 Sufficient notifica on rece ve : es No Special Conditions OF APPROVED• Inspector Date_ SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST ` DATE OF REQUEST: Z- c> 7 / TIME: BY: ���-ZZ//yL> ��G ti?�!�/l3//�(� FOR LOCATION: DAY INSPEC. NEEDED /%�G��'��� �Z'/Z��j'/ TIME: TYPE OF INSPECTION: ( �(' ) SANITARY/LATERAL (PERMIT .NO. ) ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE: / 'Z ) ,Z- `) C4 TIME: 2 ! 3 i� I N S P CONTRACTOR: leltll-ct WEATHER: L/67-CLA © � —z� ,J,ll v WORK IN PROGRESS: 2 12 _ `1 �- ` '3� A•n.,. �yt,u.= / ,� G�k �r�17 ` �� �( Lry� an�4L1 � � f yt%��>Jl�e � r � C �-M° C-•�'"(/�ZL(-f_/�1 ��.t���-C��.�tEf� �. - r fm, AREA OF CONCERN: ���t'i�%� � w•�LactL SPECIAL INSTRUCTIONS: aale 'd-�Zlq le, 4A-4-4 12 16 `i 4 9: 3 o c��t�ic.0�t,Q, yi1�!; 44c 50 o L_" �-7 t