HomeMy WebLinkAboutDrain Layers Permit 30 Overlook Road `77,
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TOWN OF SOUTH Wi N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT s�
.1111 V 2A ,_: 19 44
Pursuant to written application, permission is hereby granted. to the
Licensed Drain Layer. named, herein to perform the work indicated below at
30 Overlook Road at premises owned by Anthony gilgUiern.
whose address is 30 Overlook Road, South Windsor and to
Lay House Drain, X Repair House Drain, Lay Main, Other
for Residential occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY .SEWAGE ( X) ,
INDUSTRIAL WASTES - ( ) , OR ( )
Connection will be made with
Show sketch of proposed work or. f ,rnish 'two (2) copies of separate drawings.
(^ ev.lOsK
OSHA REQUIREME TS MU T BE ,FOLL WED
SPECIAL CONDITIONS
Desired Starting Dat g_a_ga Estimated Time for Completion 2 clays
Permit to be issued to DS. East ford
the holder o-f Drain Layer' s License No. 20b440 0 Permit wilr 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 Drain 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 $ � Check Number Ll
Connection Charge Receipt No. 40.7. Dated " '` %
Issued by �
INSPECTION
Date work started - Date completed
Sufficient notificafi3n receives : Yes Nb
Special Conditions
APPROVE
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 'may TIME:
BY: ,��G�G �� FOR LOCATION:
DAY INSPEC. NEEDED f7 -03-�jy TIME:
TYPE OF INSPECTION:
( � SANITARY/LATERAL (PERMIT NO. 61-1�z- ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP:
CONTRACTOR: � '' WEATHER: o �
WORK IN PR GRESS : Al
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: