HomeMy WebLinkAboutDrain Layers Permit 75 Quail Run TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 4°
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work dicAted below a %t,42�
(
at premises owned by r �`•J �"J- _T� whose address is
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 (X. INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date -7 1-77 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� n <::'�• . `c. . __-
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 L` Permit Fee: Paid$
Check Number
Issued by
Tax Office
INSPECTION
Date work started _ Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: Z-
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: p
BUILDING ADDRESS OR LOT N': r!0 a
STREE F
R. CJ
n
SUBDIVISION:
0
IVH STATION :
NORTH ARROW INVERT ELEV:
C�lye
TIE TIE
FT D
F T.
HOUSE LATERAL LATERAL _ HOUSE
CONNECTION STUB STUB l CONNECTION
FT. 3D�7o
INV. ELEV. INV.ELEV. F= J �FT.
BUILDING U. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST)
� (LF EXIST.)
TIE
TIE
Q
AM STATION : //CC���+ 0
INVERTELEV: V 7' S7
J cod 3t
CONTRACTOR (PRINT) NAME OF CON ACTORS SUPERVISOR(PRINT)
- oa' ll� ; 'O
STREET ADDRESS SI NATURE DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
l
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW —CONSULTING ENGINEER/DEVELOPER