HomeMy WebLinkAboutDrain Layers Permit 19 Porter Green r. ,sy. ,v',•7yTazwiy�w '..iwwr+FvlT+_':+..
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated, at..,
'/lr2.D at premises owned by
whose address is a o
Lay House Drain, Repair House Drain, Lay M& Other
for ,
x,10 /
occupancy or uae,
Family Units ,/with ?Iel ace-a.
Type of Sewage to be connected under this permit : ,SANITARY SEWAGE (1
INDUSTRIAL WASTESr ( ) . OR ( ,.)
Connection will, be made with 3�R.; S salt
Show sketch of proposbd work or furnish 'two (2) 'copies of separate drawings.
OS A REQUIP>EM TS MUST
BE FOLLOWED
SPECIAL CONDhTIONS D h- SD Q h �Pf aw-6O
Desired Starting Date 5--/ —9 Estimated Time for Completion
Permit to be issued `to --Johy1 tq I-aV�S
the holder of Drain Layer's License No. r =3p Permit will expire thirty
(30) days after date of issuaitice. 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. „.an:d/or
CHD Permie No,
Signed.;
N." Li sel main 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
skr Rkme of `the Town of South Windsor :
µ ;
! -94 -
Engineer ng Dept. Date
Permit Fee Paid $ ��' Check Number � �
Connection Charge 'Receipt No. sfy Dated.
Issued by
INSPECTION
Date work started T — Date completed
Sufficient notificat on rece ve ryes No
Special Conditions
APP
Inspector -Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: ��- /9- TIME: �-a
BY: J lyl---r FOR LOCATION• -*
DAY INSPEC. NEEDED 7 / �'r 9 � TIME:
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT NO. ) ( � ) FOOTING DRAIN
( } EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE:_ �� !� - c`J TIME: :�a )0. 44, INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
.27/?2
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: