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HomeMy WebLinkAboutDrain Layers Permit 148 Oak Street TOWN OF SOUTH Wl N DSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT6 0- '- U 19�� Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform the work, indicated below at at premises owned by / Z_ S' f ;J`1 _*hose address is and to Lay House Drain, e--,r Repair House Drain, Lay Main, Other , for S !j z'� — 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 75 Show sketch of proposed work or furnish two (2) copies of separate drawings. F Cc ©4e , g�r G1 AS G©OP SPECIAL CONDITIONS Desired Starting Date 5 :2.1 Estimated Time for Completion Permit to be issued to _,' ,� 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 Licensed D arar 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 Department Date Connection Charge Paid Permit Fee: Paid $ Check Number Issued by Tax Office INSPECTION Date work started Date completed Sufficient notification received: es No Special Conditions APPROVED: Inspector Date— TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION:` j 1 BUILDING ADDRESS OR LOT N l 7 /< STREET: SUBDIVISION: 1 NH STATION : + NORTH ARROW INVERT ELEV: TIE TIE -FT -FT. HOUSE ___ LATERAL LATERAL :INV. HOUSE CONNECTION ST UB STUB FT CONNECTION BUILDING INV. ELEV. INV.ELEV. INVU. . ELEV. ELEV. BUILDING (IF EXIST.) (IF EXIST.) r TIE TIE NH STATION : t j� INVERT ELEV: CONTRACTOR (PRINT) i- - NAME OF CO TRACTORS SUPERVISOR(PRINT) t STREET ADDRESS SIGNAT E DATE TOWN STATE ZIP INSPECTED BY TOWN 6ATE ) v-:-sr TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER