HomeMy WebLinkAboutDrain Layers Permit 70 Oak Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS.
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ! 6295
19 �f
Pursuant to written application, permission is hereby granted Co the
Licensed Drain Layer named herein to perform the work indicated below at
'70 OA 16 at premises owned by u
whose i ? CA le- ST - and to
—av House Drain a, Lay Main, Other ,
for occupancy.or use, with Si�GC
Family Units , with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ,(✓S,
INDUSTRIAL WASTES ( ) OR ( )
Connection will be made with " PUG.
Show sketch of proposed work or furnish two (2) copies of separate drawings .
OSHA REQUIREMENTS MUST BE FOLLOWED
SPEC.IAL ;CONDITIONS
Desired Starting Date TvL'j 10 Tg Estimated Time for Completion 3 DP4Y5
Permit .to be issued to . u0c TfZUC.T)1N 1N�'
th.e holder of Drain Layer' s License No. P77 01 ,(y . 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
Licensed Drain„j.aye
The above named Drain -Layer has a valid license issued b(y, State of
Connecticut and . has filed a satisfactory and and insurance policy in the
name of the Town of South Windsor:
- E g ing Dept . Date
Permit Fee Paid $ 2�'-(,� Check Number ]
Connection Charge Receipt No. 1Dated "7--7-5,�►
Issued by
INSPECTION
Date work started 7At71: Dane completed
Sufficient notif ic.a€ron ece ve : dyes No
Special Conditions eJ` '
APPROVEA4;=&CAW/,99L ''h
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
{'1 DATE OF REQUEST: / / J� TIME:
BY: 61t L e - FOR LOCATION: 70 44.4--
DAY INS.PEC NEEDED -/U�' ',f� TIME: f D �
TYPE OF INSPECTION: p
( t/ ) SAN17ARY-/IAT`ERAL (PERM-IT.'NO=.6Z FOOTING-<_DRP I.I�;_
( } EXCAVATION (PERMIT. NO. ) ( j OTHER
INSPECTIOWREPOKT
,- DATE., 1& 9 TIME: .'so INSP
CONTRACTORi lz
WORK� IN'PROGRESS:. !�
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: