HomeMy WebLinkAboutDrain Layers Permit 375 Nevers Road y" 13�9 T
TOWN OF SOUTH Wt N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT -0 5733
19 -qa
Pursuant to written application, permission is he eby g anted to the
Licensed Drg4n Layer named herein to perform the work indicated below at
�'�5 �VCL)L<2, �� at premises owned by J�''k </ Q
whose address is 315 EWA-( /0 � and to
Lay House Drain, ✓ Repair House Drain, Lay Main, Other ,
for 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 V
Show sketch of proposed work or furnish two (2) copies of separate drawings.
� 1
I
J
SPECIAL CONDITIO N
Desired Starting- Date Estimated Time for Completion 2
Permit, to be issued tk foutwJ
the holder of Drain Layer' s License No. p ._ 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 per it and the reverse side
thereof. Applicant has received Town Permit No. and/or
CHD Permit No. ,� f Y O 99 .�
Signed
Lice se Dra n Layer
The above named Drain Layer has a valid license is by the State of
Connecticut and has filed' a satisfactory bond and insu ce policy in the
name of the Town of South Windsor:
Engineering -Dept. Date
Permit Fee Paid $ Check Number
Connection Charge Receipt No. 3� Dated
Issued by
INSPECTION
Date work started Date completed
Sufficient notification received: es No
Special Conditions
APPROVED:
Inspector Date
_....mot
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: '1" ! 2-
BUILDING ADDRESS OR LOT N' : 3 5 Izjwef4
STREET:
SUBDIVISION:
0 77
NH STATION : +
NORTH ARROW -- INVERT ELEV:
U.
TIE TIE
-FT -FT.
HOUSE LATERALm LATERAL _______ HOUSE
CONNECTION STUB STUB CONNECTION
T. 611
F s�+
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) f QFEXIST.)
TIE TIE
W STATION : t
INVERT ELEV:
�OU � coy��- CO . tAC M (�f Coveo, s
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
b6% 5-11 r s m r-if� yh len
STREET ADDRESS S NATURES DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER