HomeMy WebLinkAboutDrain Layers Permit Oak Meadows/Podunk C TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 6015
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Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
Gad h ec�CPO at premises owned by a t-,e
whose address is and tq
Lay House Drain, Repair House Drain, Lay Main, Other ,
c
for Dfkvinf/? occupanor use, with
Family Units, With acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (v<
INDUSTRIAL WASTES ( ) , OR
Connection will be made with R PUC _ rya:-,
tUa
Show sketchlof proposed work orfurnish 'two (2) copies of separate drawings.
SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date ��_ 2�7, _ c,t Estimated (Time for Completion,
Permit to be issued to f(1--��-,—(`c 1��7�;+�� N� 7I�:J70/\/
the holder of Drain Layer's License No. oFS GG 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
The above named Drain Layer has a valid licei�'se issued by the State of
Connecticut and has filed a satisfactory bo d'``and ` insurance policy in the
nameAZ 41
of the Town of South Windsor: _ f
I
E ginej g ,Dept. Date m
Permit Fee Paid J Che� umber Crl �k-$
Connection Charge Receipt No. — ated ---
Issued by
1
INSPECTION
Date work started Date completed
Sufficient notificaflon ecelveal. Yes No
Special Condit ps "
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: I O�D�I '1 TIME: raao
BY: Z) Cad y\ s FOR LOCATION:
DAY INSPEC. NEEDED TIME: go
TYPE OF INSPECTION:
SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( OTHER
INSPECTION REPORT
DATE: TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: C\\-ay\ck3 TIME: Q Zo: fern
BY: cc��\`n FOR LOCATION: �C1��ec��oyJ
DAY INSPEC. NEEDED_ c� �a TIME:
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. OTHER
Gc t5
INSPECTION REPORT
DATE: Q 2 7 _ 3 TIME: /l : I s INSP:
CONTRACTOR: WEATHER:
WORK .IN PROGRESS: � �,D �/J2� Ca4L
r d
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: