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HomeMy WebLinkAboutDrain Layers Permit Lot 56 Ridgefield Dr TOWN of SOUTH WI N DSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT ® 2 6224 19 19,�/ Pursuant to written application, permission is hereby granted to the Licensed Drain Layer nam d herein to perform the work indicated below at Qt G -,'G' j', at premises owned by lzzg�cu whose address is and to Lay House Drain, Y Repair House Drain, Lay Main,_ ; Other for occupancy or use, with. t Family Units, with acres . Type of Sewage to be connected under this permit : SANITARY SEWAGE INDUSTRIAL WASTES ( ) , OR ( ) Connection will be made with - Show sketch of ,'proposed work or furnish., two (2) ,co;pies of sefpa s' #° drawings. OSHA REQUIREMENTS MUST BE FQI,dLOI.D SPECIAL ONDITIONS '>�-r► ti f. Desired Starting Da"t,e :2.z Estimated Time-.<fg. ,Completion Perm'it. ,to be issued to , the holder 'of Drain Layer's Lic se o: 7 . Permit w expire thirty ( 30) days after date of issuance. The undersigned Draiz'. `Laye'r hereby; agrees to all the terms and conditions set forth in the permit and the reVZrse .s'ide thereof A pplicant has received Town P*ergit No , and/orl Signed Duce sed in Dyer The above , named Drain Laysr has valid license issued b.;y 'thae State of Connecticut and . has filed a sarisfa'Ggf.y bpd an,d insurance policy in: the name. of the Town of South Windsor_s z �„� � inaer3n� T1ep't• � Permit Fee Paid $. ,�•*` CheC N' br �g Connection 'Charge Receipt No.,, © Dated Issued'h;y {` 2 INSPECTION Date. work started -C� r � Rate completed _ 4- Sufficient notific ec _ es " No , Special Conditions APPROVED• 2 -ZZ - Inspector Date SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: �2� `� TIME: /72ow BY: ��7 �Zt/J=7— FOR LOCATION: DAY INSPEC. NEEDED �/� l Z����{ TIME: `-r'1141t TYPE OF INSPECTION: ( � ) SANITARY/LATERAL (PERMIT NO. ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE: f Z� L2 -9 4- TIME: 30 ,/YI- INSP: CONTRACTOR: ` `D , WEATHER: WORK IN PROGRESS: Q.,-` i,�Ll 'at d, 2 VIM L , AREA OF CONCERN: SPECIAL INSTRUCTIONS: