HomeMy WebLinkAboutDrain Layers Permit 65 Quail Run TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
Cam'' DRAIN LAYER'S PERMIT 4
C,
19 //
Pursuant to written application, permission is herby ranted to the/Licensed Drain Layer
named herein to perform the work ind3r-ated below at Lc f f 2 �j�, 'r cam.
at premises of d by " �0, 57 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 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 Estimated Time for Completion
Permit to be issued to is-�c=�. �� 5-
the holder of Drain Layer's License No. Z S Z -; 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�, �--f �
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 Permit Fee: Paid $ �
Check Number (2 , t?
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
^
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION. 3 �� I
BUILDING ADDRESS OR LOT N' • D ��
STRE T.
SUBDIVISION: I/J�
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NH STATION :
NORTH ARROW INVERT ELEV: 3-� S'
-76
TIE TIE
__FT F T.
HOUSE --LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
_FT hl / �d 30/• 12
Z�F
T.
BUILDING INV. ELEV. INV.ELEV. 1.4 INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) (I F EXIST.)
TIE TIE
W STATION : +�®
INVERT ELEV: ,3 ) '-677
CONTRACTOR (PRINT) NAME7NTR ORBS SUPERVISOR(PRINT)
M)l
STREET ADDRESS SIG ATURE ATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW —CONSULTING ENGINEER/DEVELOPER