HomeMy WebLinkAboutDrain Layers Permit 314 Oak Street�.... ._. _ .� .-�_ ....,.ark ^r'")Zi.1 >. x'? R+• ,^Pr'•3 � f ... _ +.t, F
6409
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: 4111?4
Pursuant to. written application, permission is hereby granted to the Licensed Drain Layer named herein to
perform work at 1¢ OAK , Lot# as indicated below,'at
premises owned by .N9N So Alf whose address is 3— oil . and
to Lay House Drain Repair House Drain" Lay Main , Other , for S/ni 6,E FiQ/Y/!,L
occupancy or use, with - acres.
Type of Sewage to be connected under this permit. SANITARY SEWACCE INDUSTRIAL WASTES l 1,
OR {1 Connecdon MY be made with (o "'PV L . All
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
indicated on the back of this permit.
Proposed start date -�_ 9(0 Estimated time for completion
Permit is to,be issued to the holder of Drain Layer's License No.,
Onlyt-holde tenses-wl/--bessued l iei
days after date of issuance. The undersigned Drain Layer hereby agrees to.all the ter and conditions set
forth in the permit and the reverse side thereof. Applicant has received T Street cavadon Permit No.
and/or ConnDOT Permit No.
Signed —7ZI— Y'4�
C'.Z5 cc� 9 C/3 a o 99 Lice sed Drain L yer L iC „
FOR TOWN USE OM Y
Permit Fee Paid$ 7. � '_(Check No.) 33 7
Y N Connection Charge S dv IReceipt No.1 09 Dated yam/
Insurance on File 0+(`l
Bond on File ( ( J This permit as hereby issued.to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on Me, sadsfactvry bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement O
Record of Sewer
Assessment Issued by _ / 1� Date'1f�'/-SG
INSPECTION
Date Work Started y_e z -96 Date Completed a y%oz - 9� e,
Comments-r��s-.6�ov woci�
APPROVED:
In ector Date .,
• � SANITARY LATERAL &. EXCAVATION PERMIT '
. INSPECTION REQUEST
DATE OF REQUEST: TIME.: �l/IiJ
BY: s �/PS ��i/!i FOR LOCATION:
DAY INSPEC . NEEDED � U TIME:
TYPE` OF INSPECTION:
SANITARMATERAL F.OQTIXG:.DRALN...
( ) EXCAVATION (PERMIT NO. } ( } OTHER
4
WSPEC- OWREPOBT . .,..
DATE ? TIME: 9.30 - 9•'yi INSp: T. i.r�i�.✓e
rr CO'NTRACTORi- '
WORK,IN PROGRESS:
G✓! f ✓rid 6L-.ti✓�O ry sT/r✓6'
STer�L e, �L O.✓ 7i/i✓iC Gie,iS.vd-jJ r .c/L LB'd
c c F.s+ vT
co.✓T�,6e'Tdi2. ys�� �iL 7E-.2 �.6�di2i t �✓d- s�►-O.•✓�'
!/�-ice- ,� .✓i�-.� .1YOf�
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: G
BUILDING ADDRESS OR LOT N
STREET:
SUBDIVISION:
NH STATION : +
NORTH ARROW INVERTELEV:
TIE TIE
-FT
FT
HOUSE _ LATEERAL LATERAL HOUSE
CONNECTION _— STUB STUB ' ==
77
CONNECTION
FT FT
BUILDING INV. ELEV. INV.ELEV. : �r E a INY; V, INV. ELEV.
(IF EXIST.) = ' BUILDING
(IF EXIST.)
TIE f,
T
1,i.. ,4 1
0
Mi STATION : t
INVERT ELEV:
CONTRACTOR (PRINT) NAME OF ONTRgTd'A UPERVISOR(PRINT) gy
STREET ADDRESS SI TURE d� Yt'. DATE
41
G (..mac+
TOWN, STATE Z P I S C ED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK- CONTRACTOR YELLOW -CONSULTINGENG INEER/DEVELOPER