HomeMy WebLinkAboutDrain Layers Permit 84 Pheasant Way TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT J 3 5,
Pursuant to written application, permission is hereb granted \to tthe Licensed Drain Layer
named herein to perform the work indicated below ate{
at premises owned by 1� ��,;:,, , ` � wh se address is
and to
Lay House Drain, t-/ 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 Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 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. (/
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 Department Date
Connection Charge Paid .y +�\ a _ Permit Fee: Paid $ t'-
-R—`�\ Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed —
Sufficient notification received: Yes No
Special Conditions
APPROVED: r
Inspector pate
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: JA@lk t4 U f --0 17h 9�
BUILDING ADDRESS OR LOT N' : N blA C L n
STREET: (�V,)*�
SUBDIVISION: L'OtEi'd ctn- lke,
e
NH STATION : al+o
NORTH ARROW INVERT ELEV: 3 �,, 3 G
TIE TIE
s
-FT FT
HOUSE _ LATERAL LATERAL ZIN
__ HOUSE
CONNECTION STUB STUB CONNECTION
0 -
FT. 3C FT.
BUIIDiNG INV. ELEV. INV.ELEV. � INV. ELEV. LEV. BUILDING
(IF EXIST.) (IF EXIST.)
TIE TIE
NH STATION : 2�3 +
INVERT ELEV: Er
.Lf, j1 . a. (20 ms-- 06 m 0-
CONTRACTOR (PRINT) NA
'I OF'CON ACTORS SUPERVISOR(PRINT)
L'Li�
STREET
.�`ADDRESS ��' SI A UREZ DATE
digzz
TOWN STATE ZIP INSPECTED BY TOWN DATE
(26:S ) feLiq - 8 1311
TELEPHONE NUMBER
WHITE - TOWN PINK — CONTRACTOR YELLOW —CONSULTING ENGINEER/DEVELOPER