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HomeMy WebLinkAboutDrain Layers Permit 15 Peachbrooke TOWN OF SOUTH WI N DSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT N0 5742 Aavzzf 19 2- Pursuant to written application, permission is hereby g anted to the Lid Drain Layer named herein to perform the work indicated below at dU at premises owned by �rc /r r whose address is p7 , ww .�0�0/ ,1j/vim rc� �„C and to Lay House Drain`, �Repair House Drain, Lay Main, Other , for 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. SPECIAL CONDITIONS Desired Starting Date o 7, Estimated Time for Completion /o 5�2 Permit to be issued to h/, G�//�,fp -� �rtifyl •. the holder of Drain Layer's License No. .2o�Z5J 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 ha received Town Permit No . and/or CHD Permit No. Sign d / --�-- 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 : Eluiber n eying Dept. Date Permit Fee Paid -$ 250 Check O2�cq Connection Charge Receipt No. L-W D ted L( 1k 2 Issued by V--,�1.17 IP& 7 INSPECTION Date work started r9 2- Date completed r(5 z9 2-- Sufficient notification receive a: _ es No Special Conditions APPROV Inspector Date • TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: 3- BUILDING ADDRESS OR LOT N' : l7 STREET: SUBDIVISION- NH STATION : + \ NORTH ARROW INVERT ELEV: LL TIE TIE -FT -FT. HOUSE LATERAL LATERAL _ HOUSE CONNECTIONO STUB STUB CONNECTION FT. �Z FT. BUILDING INV. ELEV. INV.ELEV. INV. ELEV, INV. ELEV. BUILDING (IF EXIST.) ( \ (IF EXIST.) ©0 TIE TIE e� NH STATION : e + INVERTELEV: , 3!a'-,7 W. }l. WILLINAA5 CONTRACTOR (PRINT) NAME F CONTRACTO 'S SUPERVISOR(PRINT) STREET-ADDRESS SIGNATURfEl DATE TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER