HomeMy WebLinkAboutDrain Layers Permit 13 Bittersweet Lane /J
TOWN OF SOUTH Wi N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
'-" DRAIN LAYER'S PERMIT 5746
02
1991
Pursuant to written application, permission is hereby granted to the
j Li,censed Drain Layer named herein to. perform the work indicated below at j
at premises owned by
whose address is Pa2 APrv— GGr/� Sao%� GtJiCWL I 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 (�f,
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 io Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's .Licensee No. ZJ�
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.
1001
S i g n 2l� '� ,
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: +
En neering Dept. Date
Permit Fee Paid $ 2 15 Check Nu ber
Connection Charge Receipt No. Rated '1
Issued byT
INSPECTION
Date work started _,,,*'Date completed
Sufficient notifica on re a ve es No
Special Conditions
APPROVED: T�LJZ
Irrspector' Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: IO_11—cal
BUILDING ADDRESS OR LOT N *6
STREET: f c-AcHbRocKe ak.
SUBDIVISION: RC_Huvot�-
W STATION : �q +
NORTH ARROW INVERT ELEV: 136-Yt
}�Z.b
TIE o TIE
r
FT. FT.
33 $
HOUSE LATERAL LATERAL HOUSE
CONNECTION STU
TI B STUB CONNECTION
FT. 13 y• FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) (IF EXIST.)
Foc-nw6 1rIJ,04T) (j)
�7."75��°RaPos TIE SY TIE
�f
i
� Mi STATION : 13 t 36
w�ti� ►HAb�� `� INVERT ELEV:
�jouc.D�L co>,c5'f�u�r16�► goat~ Exc��-r��
N KEW Pm 8E
CONTRACTOR (PRINT) NAME OF CONTRACCrTO 'S SUPERVISOR (PRINT)
-1591Nr mw c&L-E 17o c0owmF RP.
STREET.ADDRESS SIGNATUR DATE
5. W)Nth,CT z �714t� , CT
TOWN STATE ZIP INSPECTED BY TOWN DATE
( ZV3 SZS-7323 / 859
TELEPHONE NUMBER
WHITE'- TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER