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HomeMy WebLinkAboutDrain Layers Permit 7 Podunk Circle TOWN OF SOUTH WI N DSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT N2 6120 19jy Pursuant to written application, permission is hereby granted to the L ' censed rain Layer named herein to perform the work indicated elow t _ 'ode-& (�tics d at premises owned by /�,��t � whose address is and to Lay House Drain, =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 p V C, Show sketch of proposed work or furnish 'two (2) copies of separate drawings . OSHA REQUIREMENTS MUST BE FOLLOWED SPECIAL CONDITIONS Desired Starting Date Estimated Time for Completion Permit to be issued to �? /lam' Jill the holder of Drain Layer ' s Licence se �To. �� 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 . 6 Signed , Liceri4ed Drai�Vy Layer The above named Drain Layer has a valid license issued the State of Connecticut and has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor: L,&�- / A ne g Dept . Date Permit Fee Paid $ 5 � Chec�Jni mber Connection Charge Receipt No. �y�t Dated 5/A 9 Issued by INSPECTION Date work started Date completed Sufficient notification received : _ es No Special Conditions APPROVED:' Inspector Date �: SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: TIME: BY: 46AGiLuQ FOR LOCATION: DAY INSPEC. NEEDED TIME: ©,3() TYPE OF INSPECTION: ( � } SANITARY/LATERAL (PERMIT NO. &/ Z O ) ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE: 5' 3 ) - 9 ¢- TIME: ?, ' Tp INSP: CONTRACTOR: / 7?�LQ- WEATHER: �/ 0'3� WORK IN PROGRESS: AREA OF CONCERN: SPECIAL INSTRUCTIONS: TOWN OF SOUTH WINDSOR .SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: BUILDING ADDRESS OR LOT N' : L7W STREET: SU8DIVIS10N: oW,.T* A�s' )49 0 NH STATION : + NORTH ARROW INVERT ELEV: a TIE TIE -FT -FT. HOUSE f LATERAL LATERAL CONNECTION J STUB I STUB CONNECTION FT. FT. BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING (IF EXIST.) U. (!F EXIST.) TIE TIE NH STATION : + INVERT ELEV: CONTRACTOR (PRINT) NAME OF CON ACTORS SUPERVISOR(PRINT) o o 4 STREET ADDRE S S I G NATURe DATE o ` ell/io TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER