HomeMy WebLinkAboutDrain Layers Permit 159 Quarry Brook Dri << TOWN OF SOUTH WINDSOR
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DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6 55
15q Quct -y g#nom D r,v-e. �
Pursuant to .written . application
Licensed Drain. "401 Layer named herein to �performgthe workeindicatedtbelow aze
�crT`/5✓ ,, # o at premises owned by �.whose address; is
Lay House Drain, Re it House Drain, La Main and to
for .�_ y Other
Family Units, with occupancy or use, with
acres.
Type of Sewage to be connected under this permit :- SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( ) (x)
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of separate drawin
gs.
SPECIAL CONDLTIONS• OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date - Estimated Time for Completion
Permit to be issued to
the holder of Dra
Layer's Li ense o,(30) drays afterda p� i7 F rmit will `expire thirty
te of, issmance. The undersigned Drain .Layer hereby agrees
to all the_ terms :and con'ditions •set : forth in the permit. and the _reverse side
thereof. Applicant .has received Town ?ermit No.
CHD Permit No.. ' and./or
Signed
is s e d Dra n er
The above named Drain Layer' has a valid license is
by. :the.. State of
Connecticut and has filed a satisfactory bo .d an insurance .policy in. the
name of the Town. 0f"South Windsor: : 01
En neering Dept. Date,
Permit Fee Paid $ �-ov
Check Number !//
Connection Charge Receipt No.. .
cZ. D ted
Issued
INSPECTION ' r..
Date work started
Sufficient Date completed
notifica on rece v
Special Conditions . 4V No
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: ��—"� TIME:
BY: Cv FOR LOCATION: /,&1 LL�
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( _ SANITARY/LATERAL (PERMIT NO. 61cf 0 � ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: $ �//_9 `?� TIME: /,4- zw INSP:
CONTRACTOR:_y/�'jIJG( WEATHER:
WORK IN PROGRESS:
f- �t Dom= cy `Lx-- '�iieti
/Oil/�G
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: