HomeMy WebLinkAboutDrain Layers Permit 106 Mountain Drive TOWN of SOUTH wI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
a 5719
DRAIN LAYER'S PERMIT Z9�
Pursuant to written application, permission is hereby granted to the.
Licensed Drain Layer named herein to perform the work indicated below at -
lo at premises owned by 7f/PR,65
whose address is /Oca MouN (DAL, S. litop C?" and to
Lay House Drain, �Repair House Drain, Lay Main, Other . ,
G
for SINGLg- FFttM ley 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. 1/G SIb7L '3
Show sketch of proposed work or furnish two (2) copies of separate drawings.
i
i
SPECIAL CONDITIONS
Desired Starting DateDate /o 9 Z, Estimated Time for Completion 3 It 7—
Permit to be issued to -77ptA Gu(4 L&4 -TZ,
the holder of Drain Layer' s License No. o2'IS .. 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
//LicenAea Drain Layer
The above named Drain Layer has a valid license issued by the State o.f
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
2
Enginee ing Dept. Date-
Permit Fee Paid $ Check Number
Connection Charge Receipt No. Dated 2
Issued by / � 1/ ��" ''-��✓
INSPECTION
Date work started /'0 -► 9 2 Date completed 3 -/d- 9
Sufficient notificaElon rec ve : es No
Special Conditions
APPR JO-9
Inspector Date
BOND O TOWN F SOUTH WIND R N2 _ _ 818
O O SO
Am't Req.' PUBLIC WORKS DEPARTMENT Date
TOWN HALL f
Am't on File 1540 SULLIVAN AVENUE Permit No.
�Date of Expiration i?,=ihz SOUTH WINDSOR, CT 06074
Permit Expires
APPLICATIONJOR PERMIT
FEE
Name and address of applicant —/M 11,gl-kcr Phone No. 7 _
1105 SeP7W-- 'Is(EQ U I C f
Location of proposed work f0G /tloun�17�4141 p4e. S.LA� ,r,
Describe fully nature of perms requested
e-e.,ey- rE-' ,4L
Insurance on file with Town yes,.; no Date policy expires A /el/ 9�—V,
c Name of Insurer I
o Approximate time for completion Z Desired starting date
Call before you dig ticket ido.
U
Show sketch of proposed work or furnish 2 copies of separate drawings
a
a _
� _.
c
0
y
0
a
v
a
a
0
U
0
+.+
O
Cd
U
a
a' Applicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG.
Q
I agree to furnish to the Town of South Windsor the amount of bond or deposit required and to
reimburse the Town of South Windsor for any expenses incurred by the Town for maintenance or repair
work in connection with this permit and that I am familiar with and will abide by the rules and
regulations for permits as outlined in the Town of South Windsor's (Pavement Cut Regulations.)
Signed--7�
APPROVED: DATE APPROVED: '` _-' ''? DATE �---
Supt. of Highways Town Engineer
FOR INSPECTOR: Date work started Date completed
Sufficient notification received: yes no Type of repair: Perm, Temp.
Unusual conditions encountered
Material slips attached: yes no Dated for Permanent repair
Signed
Inspector