HomeMy WebLinkAbout108 Oakland Rd - Drain Layer Permit TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS f
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5967
' i9y 17 19 43
Pursuant to written application, permission is hereby granted to the
Licensed DrainLayer named herein to perform the work indicated below at
/Oe at premises owned by I—Vlt, ' zllqp���
whose address is log p.4a,*/ q � �,�] and to
Lay House Drain, __Repair House Drain, Lay Main, Other ,
for P?FSi,Dr C—;, SE►ti _� LoVE occupancy or use, with
Family Units , with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE k)6 ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of separate drawings .
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date --5 - /'7 /2( 3 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 . .
czA 93 Signed
Licensed Drai 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 :
gin ing Dept . Date
Permit Fee Paid $ 2,3%0 Q Chec iumber
Connection Charge Receipt No. Dated Z3 3
Issued by
INSPECTION
Date work started Date completed
Sufficient notification rece ve : es No
Special Conditions
APPROVED:
Inspector Date
Date: j- Form No. PMT-1 Rev. 4/84 Application form must be
P I r r 3 State of Connecticut filled in completely and
Department of Transportation mailed or delivered to the
Fee: (for DOT usej Bureau of Highways Bureau of Highways District
Office. //0 7
APPLICATION FOR PERMIT RO-&- Allt-L C'olv,\)
LOCATION OF PROPOSED WORK: D}" L AIL
(a) Town:S^U3l'H N�r!'��SOS (b) Route: �30 (c) Street Name&No:
(d) (Circle Oneo S. E. W. side of Highway. (e) Located Between Utility Poles No. �y Er?ST A& No.51V %
"714 C (3c.'CiTLr'I','�j
(f) Distance and direction from nearest intersecting road.' Miles(N. S E. W.)of 1st/Rd)
Application is hereby made to: (Describe fully&include sketch or attach plans) €X c/ST1,-)C;
�iV 7-4 G- ���,�J p>C Ho E f_&i,kJ-,;E;f L /P h' i )0114- L_
ir•I ram'S C�45:t l ' 1./ �_ &7 71�,,tS•6
z1f iF
A/f:
7 �P/ Off 6L r_,E n.r-
04,
PERMIT FEE can be paid only by check or money order payable to Treasurer - State of Conn.
Names of Surety Company & amount of Bond Permit to be issued to:
CAr Name: �Jl�.;^�'I J LA-7—
Party to whom bond is issued: & _
Print Name C—iJ l
Signed -/ +�Phone C�E� //� Address:. J
Party to whom Insurance is Issued: / Town: ZIP DJ
Print Name ��U='/f'r"{ � ��f.—� /�`r-� The owner of the property for whom this work is being
performed agrees to accept all future maintenance responsibility
Signed ',' Phone for the work specified in the permit.
Approximate Time Required Desired Starting
Date Print Owner's name +
Complete Plans and Specifications must be submitted Address: /Q 9R�f cr?r✓J /F/! ,SOJi fY Gs/i�t R C r
for major encroachment permits. On other work a
careful sketch shall be shown in space above or on back side
Signed:
of application.
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT ! 5967
f'lA r 7 19 9__�3
Pursuant to written application,' permission is hereby grantedto the
Licensed Drain Layer named herein to perform the .work indicated below at
�.4E 42 �. at premises owned by 1471/1t?,Pr
whose address is /o 0.9 RIO and to
Lay House Drain, Repair House Drain, Lay 'Main, Other
for RESID/9/✓C_�_ SFwV 4.m J jz 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 or furnish "two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST B FOLLOWED
.Sp CIA COND IONPle
Des e S arti Date 7_ / s Est aced Time for Completi n
Permit to be issued to 44711L iP/06 YAG
the holder of Drain Layer's License No. Permit will expire thirty
(30) days after date of issuance. _ The undersigned brain 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
1;
L^ fte �. /g2 Signed
Licensed Drai 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: r
r- , /
a
EjginkaWng Dept. Date
Permit Fee Paid $ Check-- umber
Connection Charge Receipt No. L 'S A Dated
Issued by
INSPECTION
Date work startedJ7 Date completed � 93
Sufficient notification rece v -yes No '
Special Conditions
APPR_
Inspector Date
P'
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