HomeMy WebLinkAboutDrain Layers Permit 18 Porter Green TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6099
• I 9±L
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer n med herei j perform the work indicated below t
22- pr mise- wned by d ,
whose address isto
Lay -House Drain, Repair 4onne Drain, Lay Main, Other 1 ,
for occupancy occupancy or use, with
Family Units, with acres.. j
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with S'
Show sketch of proposed .work or furnish -two 2) copies of' separate drawings.
OSHA REQUIREMENTS MUST BE OL OWED
SPECIAL CONDITIONS 02,444 Q6E'6S
Desired Starting Date --4�—a4 Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 499re,� 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 sidethereof. Applicant has received Town Permit No. and/or
CHD Permit No. j
Signed
icensed ain L ger
The above named Drain Layer has a valid license i4r§ued b the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
Engineering Dept, Date
Permit Fee Paid $ �7_ c�u Check Number -i h 4(
Connection Charge Receipt No. 4/4 -z_0, Dated //-Jy _041,
Issued by
INSPECTION
Date work started Date completed 4- -Z
Sufficient notif icaf' o ve 'yes No
Special Conditions
APPROVED. —
Inspec'tor Date
*j SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 2No,-,,\ TIME: (\m
BY: S011 FOR LOCATION:
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( ✓) SANITARY/LATERAL (PERMIT NO. CBOT) ( ) FOOTING DRAIN
( } EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: r�_�j - TIME: l/".7p - f: y O INSP:CONTRACTOR:— ,-) WEATHER:
WORK IN PROGRESS: la.-A 1%2
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: