HomeMy WebLinkAboutDrain Layers Permit 7 Podunk Circle (2) TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS j
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6 114
s/re , 19
Pursuant to written application_, permission is hereby granted to the
Licen Drain Layer named herein to perform the work indicated below at
Awl yV l 0 G Z % at premises owned by gd,,41
• whose address is / SD v //.tJb tJ �� —'T � 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 ' (Y ,
INDUSTRIAL WASTES ( ) , OR
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
ZCIAL
t 0 CONDITIONS
Sp
L
A REQUIREMENTS MUST BE FOLLOWED
i
Desired Starting Date .S Estimated Time for Completion ,Q
Permit to be issued to A-,oe 7Q,
the holder of Drain Layer' s License No. �n3_�2�• 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 D ain. 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:
s1-6 --gy
Engineering Dept. Date
Permit Fee Paid $ Check Number 'Q1
Connection Charge Receipt No. Dated
Issued by
INSPECTION
Date work started - 9 9 Date completed 5- 16 -e9
Sufficient notification rec i-ve�ic ,-_----Yes No
Special Conditions
01
APPROVED•
nspector Date
SANITARY-LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: Q.� TIME: / 2 ov clooc�
BY: FOR LOCATION:
DAY INSPEC. NEEDED (`� 5L TIME: CCQp r k_ la:cc>
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. ClI ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
A, /,'jo
DATE: TIME: -14` INSP:
CONTRACTOR: G(R WEATHER: S °J'
WORK IN PROGRESS:Q /
s � r
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: