HomeMy WebLinkAboutDrain Layers Permit 20 Porter Green TOWN OF S OTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL !
DRAIN LAYER'S PERMIT 307
L�s
Pursuant to written application, permission is hereby granted to the
Licensed -Drai Layer named herein to perform the work indicated below at
/ `ccr1 at remises owned by
whose address is
Lay, House DraAn, Repair Mtise Drain, Lay-Maid, Othnr
f o r -----
� ,y occupancy or use, .with
Family Units:, ith _acres .
Typdj=_of Sewag4 to -be connected under this permit : SiNITARY SEWAGE ( ,
INDUSTRIAL WASTES ( ) , OR
Connection will be made,wiah '
Show, sketch of proposed work or , furnish two .(2) c p es of separate d.ra� ings .
OSHA REQUIREMEN S UST HE YOLLOWVE
SFECIAL CONDITIONS J'
Desired Starting Date ,Estimated Time for Completion
Permit to be issued to -�1f� � '�(,,?aS the holder of Drain Layer 's- License No . Permit will expire thirty
(30) days after date of issuance.. The undersigned !Drain Layer hereby
� y y agrees
to all the terms and conditions set forth in the permit and the reverse side
thereof . Applicant has repeived Town Permit No . and/or-1
CHD Permit No .
Signed
IA
ce ed ain Layer
The above named Drain Layer has a val license is ued by 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 $ Check Number t0
Connection Charge Receipt No. .6:5''30:2 ated 7Ae-1 i
Issued by !
INSPECTION
Date' work started 7 Date completed
Sufficient notifica on rec ve : es No
Special Conditions
APPROVED: l/ 2 31 1
Inspector Date
SANITARY LATERAL..& EXCAVATION PERMIT
INSPECTION REQUEST
DATE'..OF REQUEST — 9S TIME
BY: c%� / ✓1, ��� FOR LOCATION:—
DAY INSPECT:. NEEDED 7— 3/ -9�0 TIME:
TYPE _OF INSPECTION:
( x ) SANITARVLATERAL":('PERM17,-"NOS. C,-3d'-.-) ) ( ° f' FOGTING DRAIN..
i ( ) EXCAVATZQN (PEFMIT. NO. ) ( ) OTHER
`NSrPECTIOWREPORT
DATE. — hL —}S� TIME: /p" INSP:
t CONTRACTOR
WORK IN PROGRESSI: 3
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: