HomeMy WebLinkAboutDrain Layers Permit 8 Podunk Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6041
195
Pursuant to written application, permission is hereby granted to the
Licensed Drain La er named herei to perform the work indicated blow at
Poi'✓h k r 1 tl at remises owned by ncial
whose address is < < L)t -,�Q and to
Lay House Drain, Repair ouse Drain, Lay Main, Other ,
for Sl-l:!�lf- occupancy or use, with /
Family Units'
ni s, 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.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date —/0- Estimated Time for Completion
Permit to be issued to C)IfC (''„l(k I c fie
the holder of Drain Layer's License No. �20&S`6G . 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 atd insurance policy in the
name of :the Town of South Windsor: j
En inee ing t. Date
Permit Fee Paid $ .;�A�) •007 Chec umber C
Connection Charge Receipt No. L ? _`O ADated \6\(\•
Issued by / -j /Ille,
INSPECTION
Date work started �� �4 Date completed /--/Q-&
Sufficient notif ic'a� of n recelvea: V Yes No —''--
Special Co ditions
46
APPROV
Inspector D
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: �\\ TIME: �30
BY: ::S` ) C� r FOR LOCATION:
DAY INSPEC. NEEDED \�X\d\n,yj TIME: c-
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
{ } EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: :D Z INSP:
CONTRACTOR: off`�— WEATHER: O `�
WORK .IN PROGRESS:
ddl
AREA OF CONCE N:
44
SPECIAL INSTRUCTIONS: