HomeMy WebLinkAboutDrain Layers Permit 8 Podunk Circle (2) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT R 6 2 2 5
C / 19 �(
Pursuant to written application, permission is hereby granted to the
Linen ed Drain Layer named herein to perform the work indicated below at
at- p r e mi s e s 9wned by ,V.
whose address is and to
Lay 'Hous,Q ,Drain, Repair House Drain, Lay Main, Other
for Fd� occupancy or use, with
Family Units , with acres .
Type of Sewage to be connected under this permit SANITARY SEWAGE 00
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 Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer ' s License No . 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
L censed Dr in Layer
The above named Drain Layer has a valid license <.Assued by the State of
Connecticut and has filed a satisfactory bond and Trance policy in the
name of the Town of South Windsor :
4 941
Engineering Dept . Date
Permit Fee Paid $ 2 45 ,00 Check Number
Connection Charge Receipt No. R. 5 `7`'` Dat d
Issued by 41
INSPECTION
Date work started 2,1-lq Date completed /
Sufficient notificaLion received _ es _ No
Special Conditions
APPROVED:�61� r.
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: I Z' ZZ`gN TIME:
BY: FOR LOCATION:
DAY INSPEC. NEEDED Z-Z,3; g � TIME: 9'*
TYPE OF INSPECTION:
( x ) SANITARY/LATERAL (PERMIT NO. TiZ.J ) ( } FOOTING DRAIN
1
( ) EXCAVATION (PERMIT NO. ) ( } OTHER
INSPECTION REPORT
DATE: (?��Z3�`��f TIME: po? INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS: h4 LL t cz/L
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: