HomeMy WebLinkAboutDrain Layers Permit 26 Pond Lane ., . �� s=�'��'`�•i -�.T'�'o'T ''r�a�yfgt a..r "`$ ''S7',�f'
' TOWN OF SOUTH W1 N DSOR
AJ&
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL W, , fo DRAIN LAYER'S PERMIT 6205
07 O C7 9Iq
Pursuant to written application, permission is he&ebv granted ,to the
Licensed Drain Layer named herein to perform the workTndicated below at
,22 #0^,Vb L./� . LA.�. at pre-mines owned by ' `B�tA/U ,FbLjAeDS-
whose address. is 21, Poti-b LA . 3. t.) , and to
Lay House Drain, Repair House Drain, Lay Main,_ Other. ,
for w-qe_ (' 1u+vFc iOA-) occupancy or use, with
Family Units, with 3c acres,
r r
Type of Sewage to be connected ujder this perm `t : S*ITARY` SEWAGE (j
INDUSTRIAL WASTES ( ) , OR
Connection will be made withs
Show sketch of proposed work or furnish "two (2) copies, of separate drawings.
C �ATf�/11.., pNq
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date e) Z8' Estimated Time for Com, letion D ? 9
Permit to be 'issued to Be(A/u Ibi-iAle0l
the holder of Drain Layer's License No. Permit Will expire thirty
* (.30f) days after date of issuance. The undersigned Drain Layer hereby agrees
to 411 the terms and conditions set for-th in the permit and the -reverse side
t-he.p-eof . Applicant has received Town Permit No. and/or.
C-HD 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 and insurance policy in the
name of the Town of South Windsor:
Engineernkg Dept. ..Date
Permit Fee Paid Check Number -_"2 '71
Connection Charge Receipt No. Datedt ..
N�^LKS7� I s s-,e d by
�'SQUU
INSPECTION
Date work started ® Date completed
Sufficient notifica . on r ce v : _ G es No
Special Conditions
APPROVED: �� Z
nspector D to
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 101Z-7h `T TIME: e*
BY: &,V-A) &-�)wX-0 FOR LOCATION: Z6
DAY INSPEC. NEEDED f`1- TIME:
TYPE OF INSPECTION:
( tx SANITARY/LATERAL (PERMIT NO. ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( } OTHER
INSPECTION REPORT
DATE:_TQ Z8` / TIME: �� 0 -r) INSP:�_
CONTRACTOR: WEATHER:
WORK IN P OG ESS:
0:i:nz
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: