HomeMy WebLinkAboutDrain Layers Permit 369 Miller Road (2) {
r TOWN Of SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
3 DRAIN LAYER'S PERMIT N2 6 O 11
3 y
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
< (� at premises owned by as,�I* C 5-{
whose address i$ '7 R I sc and to
Lay Howse grain '- Repair House Drain, Lay Main, Other
for �� �s t r �«� occupancy or use, with , t
Family Units; with yZ acres.
Type �of Sewage to be connected under this permit: SANITARY SEWAGE 4, .
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with (� '' VE
Show sketch of proposed work or furnish 'two (2) copies of separate drawings. a
P&/f7J!Z
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date � ,� 2 Estimated Time for Completion
Permit to be issued to )C�{,.1
the holder of Drain Layers, License No. �26 & .51,114 Permit will expire thirty
(30) d`ays after date of issuance. The undersigned Drain Layer hereby agrees
to all the terms and 'conallions 'set _ for th in the permit and the reverse side
thereof. Applicant has received Town Permit No. and/or
CHD Permit No.
Signed 6,e4-1
�4r�,=., �
o Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactor bond and insurance policy in the
name of the Town of South Windsor
En ine g Dept. Date
Permit Fee Paid $ � �� Chec umber z
Connection Charge Receipt No. Ll ,'�'C� ated ,g�q
Issued by y
ly
INSPECTION
Date work started —2, � 3 Date completed
Sufficient notificationfrecei've�: s
Special Conditions
APPRO �` ._
4h4ector Date
TOWN OF SOUTH WINDSOR
.SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 911193,
BUILDING ADDRESS OR LOT N® : .3
STREET:
SUBDIVISION: X344 Z&f 6YLrZW41bi
0
NH STATION : - +
NORTH ARROW INVERT ELEV:
U.
TIE TIE
F T. _FT
HOUSE ____ LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT A962 FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEU. V. BUILDING
(IF EXIST.) 7 1 p (IF EXIST.)
TIE TIE
NH STATION : +
INVERTELEV:
r�rl.� I�J,,i,//,,
CONTRACTOR ( I T) NAME OF CONTRACTORS SUPERVISOR(PRINT
s � sr ` _ q
STREET ADDRESSJ SIG ATURE
TOWN / ?2 /STATE/ ZIP INSPECTED BY TOWN
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING E
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: -9� TIME:
BY: 12Q' FOR LOCATION:
DAY INSPEC. NEEDED 9- 2 J 3 TIME: 910
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. p ) ( } FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
q, INSPECTION REPORT
DATE: 9 ^ 2- l TIME: J J Co INSP:
CONTRACTOR: WEATHER: a
WORK IN PROGRESS: '
I r
• r
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: