HomeMy WebLinkAboutDrain Layers Permit 19 Overlook Road TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION. CONTROL
DRAIN LAYER'S PERMIT N2 6253
3 a - 19 9S
Pursuant, to written application, permission is hereby granted to the
Licensed Drain La{'er named herein to perform the work indicated bel w at
I Ovcn. leo k Ps at premises owned by �.�.�«.,n c 1( (;ks. a i �D�i .
whose address is 15 .4,, h l oa,� "Z� , S6414 uj,, and to
Lay use Dr in, r��_Repair Ho se Drain, Lay Main, Other ,
for 1 � occupancy or use, with
Family Units., with nacres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE . ( L
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch of proposed, work or furnish two (2) 'copies of separate drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date: Ltyh 1gS't Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No . aoG_ �a�/G' Permit will ex ire 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 Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and . has filed a satisfactory o d and insurance policy . in the
name of the Town of South Windsor :
�Yu
ine g Dept . Date
Permit Fee Paid $ � Checkmber 119U /
Connection Charge Receipt_No. .L�.--- D ted a '30 '
Issued by 3 '-3/- 7
INSPECTION
Date work 'started Date completed
Sufficient notifica on ece Va es No
Special Conditions
APPROVED: _7,,_,�!� '-f`93.�
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
lop INSPECTION REQUEST
DATE OF REQUEST: 17'-0 3 `i TIME:- P7oz
BY: j�JLz�� r- -- S %L i/GTSi�72i' FOR LOCATION:
DAY INSPEC . NEEDED TIME: i
TYPE OF INSPECTION:
( Q� ) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE:- ��/ 5 TIME• /) `3�;,1 INSP: ✓/"`�-'/�
CONTRACTOR:- ' ' WEATHER:
WORK IN PROGRESS:
/7`�y-✓�L. t,c�.f--5' ale.' �� �J/�-t`�-- yi— �r-Gam` /I�"
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: