HomeMy WebLinkAboutDrain Layers Permit 8 Gardinia Lane ,.
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TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
b` BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 5679
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Pursuant to written application, permission is hereby granted t the Licensed Drain Layer
named herein to perfo the work ind' ated below at Qeac.N �Sa�IC r L OTV1cF
at premises owned by fc7t�M , , e<S whose address is
;� fl-7 U)1E -o n C—T and to
Lay House Drain, Repair House Drain, Lay Main, Other
for occupancy or use, with S,nGJ �
Family Units, with acres.
Type. of Sewage to be connected under this permit: SANITARY SEWAGE (4, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
/(,ovCo ?�v
SPECIAL CONDITIONS
Desired Starting Date I Estimated Time for Completion / We
Permit to be issued to (�Q,�,p ���,`e, _ M EkCAUA-ri n g S 2U+ceS, Itic
the holder of Drain Layer's License No. P1z.036,2(o. Permit will expire thirty (3 ) 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 I �
Licensed Drain Layer
The above named Drain Layer has a valid licen a )he
sued by the State of Connecticut and
has filed a satisfactory bond and insurance policy name he Town of South Windsor:
En Yne i Department Date
Connection Charge Paid 7cQ �� �C'�/�r Pe it Fee: Paid $
C� c Number
Issued b 1
Tax Office !
INSPECTION
Date work started 'Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: —11`gl
BUILDING ADDRESS OR LOT N° :
STREET: ( DEN A LANE
SUBDIVISION: f=1 $(�opy(�
Mi STATION : L3 + 30
NORTH ARROW F'r'
: 12�•J�f
TIE TIE
FT FT.
HOUSE HOUSE
LATERAL
CONNECTION STUB STUB CONNECTION
FT I Z?.�G FT.
BUILDING INV. ELEV. INV.ELEV. INVU. . ELEV. INV. ELEV. BUILDING
(IF EXIST.) (IF EXIST.)
rl ,z �
TIE -9 TIEtj
gz
«ifM STATION : -1 l f rio4
INVERTELEV:
_ 4
ctelm y `o �+� I��ntr1 _�3Rorh ��I►c��25
CONTRACTOR (PRINT) NAME F CONTRACTOR S SUPERVISOR (PRINT)
STREET.ADDRESS / SIGNATU DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
( 2-03 ) 5'2 8 73 z3 / 6" -- z561
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER