HomeMy WebLinkAboutDrain Layers Permit 44 Oxbow Lane t
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N ;6`2 1 G
19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Lager named herein to perform the work indicated below at
D % 44 6.* hcvJ L aAk-k--- at premises owned by oc $o✓Y'-F--A
whose address is - and to
Lay House Drain, L,- Repair House Drain, Lay Main, Other ,
� f:or occupancy or use, with
Family Units, with acres .
` Jype'_of :Sewage to be connected under this permit : SANITARY SEWAGE (v};
INDUSTRIAL WASTES ( ), OR ( )
Connection will be made with
Show sketch, oof.- proposed work or furnish two (2) copies of separate drawings .
OSHA REQUIREMENTS MUST BE FOLLOWED
SPCnI4L ..CONDITIONS
Desired Starting Date 2 2- Estimated- Time for Completion /Z - G;- S
y
Permit to be issued to S 'r�rSct�,=r � � (� «¢-w.f
the holder ofr Drain Layer 's License No . 2v 3 Permit will expire thirty
( 3'0) , days. afler date of issuance. The undersigned Drain Layer hereby agrees
to all. the, terms and conditions set forth in the permit and the reverse side
M t.here0f . Applicant has received Town Permit No . and/or
C<HD :Permit No.
Signed �L�
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
Connection Charge Receipt No. 151 2- Dated
Issued by ,/ L�r� a`./d�! 7_'
INSPECTION
Date work started �2, -.!'A - Date completed
$-uf ficient notification rece3vea. —yes No
Special Conditions '
APP /Z-5
nspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: L ' - TIME:
BY: FOR LOCATION:
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. G Z.- / } ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( } OTHER
INSPECTION REPORT // o
DATE: / 2, e".- �- TIME: �Q ('� G� INSP: D �Z,GCLt
CONTRACTOR: 04-
WEATHER: �..�
WORK IN PROGRESS:
; �
al Ay,
iAl
C)Ct CI-1b 1r
f! ff
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: