HomeMy WebLinkAboutDrain Layers Permit 85 Nutmeg Road South _ k
TOWN OF SOUTH Wi N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6043
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
S Nuf'M�eli oJ S hA at premise owned by r Cv
whose address is, c Rvd S 'a to
Lay House Drain, Repair House Dra n, Lay Main, Other a ,
for j4, 4r occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE (L
INDUSTRIAL WASTES ( ) , OR ( ) --
Connection will be made with
Show sketch- of proposed work or furnish 'two (2) copies of separate drawings.
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date �� �T1z Estimated Time for Completion I
LL
1 re
Permit to be issued to �` , , - ,Id C-4
the holder of Drain Layer's License N . ql 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
Lice sed in Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor: J
Engineering Dept. Date
Permit Fee Paid $ Check Number
Connection Char a Receipt No. Dated
Issued by
INSPECTION
Date work started Date completed
Sufficient notification rece ve : Yes No
Special Conditions
APPROVED:
Inspector Date
r
{ SANITARY LATERAL & EXCAVATION PERMIT
y
INSPECTION REQUEST
DATE OF REQUEST: TIME:
BY: FOR LOCATION:
DAY INSPEC . NEEDED TIME:
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: