HomeMy WebLinkAboutDrain Layers Permit 10 Pond Lane �- TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
5510
DRAIN LAYER'S PERMIT '��,
/0 - /a 19 id
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at /0 70,Aj7j G'�q
at premises owned by L i ",U,q G 0 N G u,e-VTZ whose address is
tl 0 rMb L A and to
La House Dr ' 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 K), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
f/�uSE
SPECIAL CONDITIONS
Desired Starting Date /o_ /-s-- p Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. p Permit w ll expire thirty (30) days
y
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. A licant ha received
Town Permit No. and/or CHD 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:
Engineering Department Date
Connection Charge Paid ` (Jy Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION
Date work started /0,40/,9,0 Date completed
Sufficient notification rec ivied: Yes No
Special Conditions
APPROVED: /O /
nspector Date
I
--- - _. ,
4
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: /0 - /7 - n
BUILDING ADDRESS OR LOT Ng :
STREET:
SUBDIVISION: 4',_V5T/AjG
0
NH STATION : +
NORTH ARROW INVERT ELEV:
1.4
TIE TIE
-FT -FT
HOUSE __ T
_ LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. FT.
BUILDING INV. ELEV. INV.ELEV. INVU. . ELEV. INV. ELEV. BUILDING
(IF EXIST)
(I F EXIST.)
TIE TIE
NA STATION : +
INVERT ELEV:
a PS 5FP77C -7'_QM Cv,4LkAg
CONTRACTOR (PRINT) NAME OF CON TORS S PERVISO (PRINT)
017 &uJz)y 37Zook R,7)
STREET ADDRESS GNAT E DATE
E� L lAI 7-0 Al C r
TOWN 0¢p� „STATE ZIP INSPECTED BY TOWN DATE
Y_l / d—a,33c:;L
TELEPHONE: NUMBER.
WHIT.- T01(VN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER