HomeMy WebLinkAboutDrain Layers Permit 29 Meryl Road �.j TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6235
'h 19 yF-5_
Pursuant to written application, permission is hereby granted- 'to the
Licensed Drain Layer1 named- ere in to perform the work indicated below at
at pr�ese owned by ZOe
whose add're is .'S 9 iX/// !'� alto:
Lay House. Drains RepalAr House Drain, Lay Main, Other - to- ,
-for occupancy or use, with
Family Units , witoh acres.
Type o'f . Sewage to be "connected under this..'permit : SANITARY SEWAGE ( ,
INDUSTRIAL WASTES OR
Connection' will be made with .S,D�
Show sketch of proposed work or furnish two (2) copies of separate drawings".
OSHA REQUIREMENTS UST E OLLOW D
SPECIAL CONDITIONS "Tpaynp�
De I4w
Desired Starting Date Estimated . Time for Completion, 06^
Permit to be issued to '3"OI� 7Q 4PU
the holder of Drain Layer ' s License N9,. P:ermi=t will" expire ' thirty
( 30) days after date of isseanc:e. ;, TW,4 unoerillgne-fl' Drain` Layer hereby agrees
to all the terms and conditions ,;set fort'h•. in t4ie' : permit and the reverse side
thereof. Applicant has received Town Permit' Igo", and/or ;Y
CHD Permit No .
�...; Signed"
Lice s d D in Layer
The above named Drain Layer has a val lice'ns iss ed by .the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
..__ Engineering Dept . Date
Permit. Fee Paid $_ � Check Number
Connection Charge Receipt No. Q,�.27, Dated_ _
Issued by .
INSPECTION
Date work started Date completed
Sufficient notifica - eceiv -Yes No io
Special Conditions
APPROVED: �!4
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
A
INSPECTION REQUEST ,p
DATE OF REQUEST: l w 6- 95- TIME:
BY: FOR LOCATION: 6 ,
DAY INSPEC . NEEDED l-- 2- TIME: _ ,
TYPE OF INSPECTION:
( K ) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( \) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTIOV REPORT
DATE: qe 95 TIME: 2! 00 INSP:
CONTRACTOR:_ WEATHER: °
WORK IN PROGRESS: G`X
3
omz
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: