HomeMy WebLinkAboutDrain Layers Permit 60 Oak Street 3 . TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT l4l 1
1.9 � y
Pursuant to written application, permission is hereby granted to the
Licen ed Drain Layer named herein to perform the work indicated below at
i N bbW�11 / at premises owned by '1410yj1-111V$Osr
whose address is (�0 Oa ,5% and to
#, Lay house Drain, Repair House Drain, Lay Main, Other
for occupancy or use, with gip'
Family Units , with 1�,_acres,
Type of Sewage to be connected under this permit : SANITARY SEWAGE ( 1� ,
INDUSTRIAL WASTES ) , OR
Connection will be made with ,$/Z2 3 S'
Show sketch of proposed work or furnish 'two (2) copies of -separate. drawings.
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Z% Scd(� MrN
OSHA REQUIREMENTS JAUST BE F LLOWED
SPECIA4 CONDI ION
Desired Carting ate ^2 Vstimdtjd Time for vCompletion
Permit to be issued to A 1 C<JvlAk .+� ��,o%'t He,9Ary
y 2_0 S'6' Permit will expire thirty
the holder of Drain Layer' s Licensee No. �
(30) days after date of issuance. The undersigned Drain .Layer , hereby agree.s
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
Licen ed Drain 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
Engineering Dept. Date
Permit Fee Paid $ � Check Number
Connection Charge Receipt No. �L�--�p�p Dated
Issued by
INSPECTION
Date work started , z. 8 9 Date completed
Sufficient notification receivea : Tes No
Special Conditions
AP
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: _z 3^�¢ TIME: /Z�
BY: �5 ,!¢ FOR LOCATION:
DAY INSPEC. NEEDED ��¢ TIME: I 00��
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT- NO. I¢ ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 6 - s e - 9 -TIME: i 3a I N S P
CONTRACTOR: x2Z:�� WEATHER: U"
WORK IN PROGRESS: feu/
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AREA OF CONCERN:
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SPECIAL INSTRUCTIONS: