HomeMy WebLinkAboutDrain Layers Permit 24 Podunk Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
f
r
DRAIN LAYER'S PERMIT NS 6266
OZ&� 0 19 �-
Pursuant to written application, permission i hereby granted to the
Licensed a'n La er asked herein to perform the work indicated el w t
Az
at raises gwned by
whose address is and to
Lay HouseDrain, 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 SEWAGE4j ,
INDUSTRIAL WASTES. ( )`, OR ( )
Connection will be made with
Show sketch of proposlaZS
urnish two (2) copies of separate drawings.
EQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to e l
the holder "of Drain Layer' s License No . �2=1a6 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 /
Li nsed Dr a Layer
The above named Drain Layer has a valid license issue by the State of
Connecticut and . has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
Engineering Dept . Date
Permit Fee Paid Check Number
Connection Charge Receipt No. Dated
Issued byt�7'°
INSPECTION
Date work started Hate completed
Sufficient notificaFion receive a ; es No
Special Conditions
APPRO 6 �s
Inspector Date
SANITARY LATERAL &-EXCAVATION PERMIT-
INSPECTION REQUEST
DATE 'OF REQUEST:_ Z/ , is TIME: l qln
BY: Pit FOR LOCATION: /.V Top ?.jr-
DAY INSPEC . NEEDED TIME:
TIME:
TYPE OF INSPECTION:
SANITARYI•LATERAL;> (PERMIT'`.NO�. Z.lo/® } ( ? FOOTING ,DRAIN,
( ) EXCAVATION (PERMIT NO. } ( } OTHER
INSPECTION REPORT,. _
3a
DATE:. - 5 TIME: 9 ` 30 - Z.dO INSPr
—_
p o-F-
r CONTRACTOR:� - WF4THER4
WORK .IN PROGRESS s. Q- C
0
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
c
�ptZ /' CrZ.vN�
MAPLE LEAF CONSTRUCTION, INC. r
P.O. BOX 613
SO.WINDSOR, CT 06074-0613
C-0 L1 A1.S[ a.,1 G
G; s�
UI L- \
i�
i
7-
ri AA kb lug