HomeMy WebLinkAboutDrain Layers Permit 96 Oak Street TOWN OF SOUTH W1 N DSOR
lot DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT � 6186
19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer arced herein to perform the work 'i dicated be]-ow at
9 at premises owned by la
whose address is K$' 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
Show sketch of proposed _work o nish 'two (2) copies of separate drawings.
7
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to - /�✓ G�G..
the holder of Drain Layer' s License No. 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
icensed Dr 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:
Engineering Dept. Date
Permit Fee Paid $ rQz,,. .._.... Check Number ._
Connection Charge Receipt No. le, f Dated
Issued by. /J�1�
INSPECTION
Date work started "g`r Date completed .
Sufficient ,notifica on rece ve " 'Yes No
Special Conditions
APPROVED: /i2T
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
;t INSPECTION REQUEST
DATE OF REQUEST: TIME:_
BY: �jG/G� C'0�5/ FOR LOCATION:
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( � } SANITARY/LATERAL (PERMIT- NO. 6106 } ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE:_ g " ��cl� TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 9''l1,9-- o/ TIME: f
BY: FOR LOCATION: g« Q/SZfC ✓� LZ7
DAY INSPEC. NEEDED �' �O - °J� TIME:
TYPE OF INSPECTION:
( I� ) SANITARY/LATERAL (PERMIT NO. ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE:- c/- 4y 9 y TIME: 8" 3o INSP: /�W/-
CONTRACTOR: WEATHER: ,
WORK IN PROGRESS: �/�i-�1 USG�� s �AOA'G ��T � l9� 7 T� A�
t'a -171pr l l 5 J /4r0vG 9 3y Pv/iL�L G jam.
i
I
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: