HomeMy WebLinkAboutDrain Layers Permit 6 Oak Meadow ii
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
_ DRAIN LAYER'S PERMIT N2 6102
19 CvA
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicat d below at
�� �UW at premises owned by A �Dti� /vim
whose address is �. GtJ ato
Lay House Dr ins, �.a Repair House Drain, Lay Main, Other ,
for h1C-Sjl��iJ�� occupancy or use, with
. Family Units, with acres.
.Type of Sewage to .be connected under this permit : SANITARY SEWAGE (X) ,
INDUSTRIAL WASTES ( ) ,,' OR ( )
Connection will 'be made with ,A It
Show sk ► f ¢�? osed work or furntfro �2) copies of ravings.
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OS RE ENTS MIAT AE YOLL
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Desired is B O q Estimated Time for Completion /:4
Permit. to be issued to
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the holder of Drain Layer's License No. G��S1� 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. I
Signed
L censed Dr in 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:
Inzunance wilt he FAXED overt
today (pe)L Agent) 4/ 11/94 Engid4 ing Dept. D to
Permit Fee Paid $ �,�U Check Number
Connection Charge Receipt No. Dated
Issued by
INSPECTION
Date work started Date completed
Sufficient notificaf on received: es No
Special Conditions
APPROVED: A—'&.1a&
Inspect r Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: \ \\ .��R�` TIME: Rwy\
BY: FOR LOCATION
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( t/� SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
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5- 4 - 54 I-Ad 'J",J tril!a
SPECIAL INSTRUCTIONS: