HomeMy WebLinkAboutDrain Layers Permit 388 Pleasant Valley TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6 2 5 4
'- 0 19
Pursuant to written application, permission is hereby granted to the
Licensed Drain- Layer named herein to perform the work indicated below at
\ @ 6, at premises own d by j_Ite
whose address is �C(140c \C and to
Lay House Drain. v Repair House Drain', Lay Main, Other ,
for `�eaN,&ewk-c'o. 1 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 sket,ct of proposed work or furnish two (2) copies of separate drawings.
ex;s +-j�a OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL ONDITIONS
Desired Starting Date cjs _Estimated Time for Completion
Permit to be issued to �c Q L �[pS, G •n �0 �( t00 O
the holder of Drain Layer 's License No. -) 0 Permit will exp re. thirty
( 30) d.ays after date of issuance. The undersigned Drain Layer hereby agrees
to a . ,A',r,the terms and conditions set forth in the permit and the ieverse side
th"er. Applicant has received Town Permit No . and/or
CHD Per- t No . pp
;Signed. CJ�
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 :
n
&ineerin 8 Dept . Date-
Permit Fee Paid $ �.-S�r�""'""""- Check Number
Connection Charge Receipt' No. gs(BB Dated` " `4
Issued by
INSPECTION
Date work started-' 3�3��qu� Date completed -j '✓?,'�'`r
Sufficient notification received: es No
Special Conditions
APPROVED:
Inspector Date
lw .
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: / TIME:
BY: FOR LOCATION:
DAY INSPEC . NEEDED r-12-7" 3—3/-�5' TIME:
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 5 — 3 i �5 / TIME: 9 5 INSP:
CONTRACTOR: L%�s ��� ��,��i �L�'lz��,=�, G, WEATHER /11Z
WORK IN PROGRESS: 42
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: