HomeMy WebLinkAboutDrain Layers Permit 486 Quarry Book Driv ,fly TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
Ail DRAIN LAYER'S PERMIT s
err 6063
Pursuant to written application :he
192
Licensed Drain Layer named hirein toy permission is hereby granted to
7c !' / perform the work indicated below at
rcc ,avo of at premises owned b
whose address is Y
Lay House Drain, Repair H se Drains 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 SE
INDUSTRIAL WASTES ( ) , OR ( ) WAGE ,
Connection will be made with
Show sketch of proposed work or furnish 'two (2) copies of separate
p rate drawings..
,f3Sa IJ
SPECIAL CONDITIONS OSHA RE4UIREMENTS MUST BE FOLLOWED
Desired Starting Date
-3Estimated Time for 'Completion
Permit to be issued to � .,� ,
the holder of Drain Layer's Lic se No �a ��
(30) days after date of issuance. -- ��- Permit �i 1 expire thirty
to all the terms and conditions set Tforthainstheed Drain Layer hereby agrees
thereof. Applicant has received Town Permit No, permit and the reverse side
CHD Permit No. and/or
Signed '�
Licensed--D Layer
The above named Drain Layer has a valid license issued by the St
Connecticut and has filed a satisfactory bond and insurance ate of
name of the Town of South Windsor: Policy in the
r Engineering Dept. Date
Permit Fee Paid $ Z g
Chuck Number
Connection Charge Receipt No. /vj`r
Dated C9 ' 7 •- _�
Issued b --------------
INSPECfiION
Date work started �
Sufficient notific—'i'o �� Date completed tZ -
Special Conditions - -- es —__ No 2 ® A
Inspector Date
SANITARY LATERqL &
EXCAVATION P
DATE OF REQUEST: INSPECTION RE ERMIT
_
2 -
BY: REQUEST TIME:
00
DAY INSPEC, NEEDED FOR LOCATION:
/Z _� ION:
TYPE OF INSPECTION: TIME:
�C ) SANITARY/LATERAL
� ) EXCAVATION (PERMIT
(PERMIT. NO
(PERMIT N0. ) ) FOOTING DRAIN
OTHER
DATE: INSPECTION REPORT
CONTRACTOR: TIME; �D d
INSP:
WORK IN PROGRESS: WEATHER:
REA OF CONCERN:
'CIAZ, 'INSTRUCTIONS:
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REOUEST
DATE OF REQUEST: �7i �/ 7�� TIME:
0
BY: ( !/ �' �- /A '� R LOCATION:
DAY INSPEC. NEEDED TIME: 41
TYPE OF INSPECTION:
( v ) SANITARY/LATERAL (PERMIT NO. (i.�� ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT /
DATE: / Z- Z d "/ 3 TIME: 3 O INSP: ado At T
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: