HomeMy WebLinkAboutDrain Layers Permit 99 Ridgefield Drive r
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 6101
Pursuant to wr t en application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
_107'_5�2 ,'�9ef:.e1271 mod`", ' T� premises owned by .C�Gi�///� ( -
whose address is y�/�f �yF; and to
Lay House Drain, _Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Famiii
nits wi- acres:
Ty p o S jFwa < _�o OR <o)nected under this permit: SANITARY SEWAGE ( ,
INDUSTR -'i '3"PL ,
Connection will be made with
Show sketch of proposed work or 'furnish 'two (2) copies of --separate drawings.
r
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to T/JPGe-�w4- l_�c�✓d�r =�
the holder of Drain Layer's Lic nse No. ' Permit will expire thirty
(30) days after date of issuance. 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. and/or
CHD Permit No.. 746 /T
Signed 9
Licensed Dra n 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
name of the Town of South Windsor:
Engineering Dept. Date-
Permit Fee Paid $ .w Check Number
Connection Charge Receipt No. Dated �1-1;kfw
Issued by
INSPECTION
Date work started Date completed
Sufficient notification rece v'a: es No
Special Conditions
APPROVED/
./ spector Date
r
SANITARY LATERAL & EXCAVATION PERMIT
' INSPECTION REQUEST
$30
DATE OF REQUEST: '�7�/6 9y TIME:-
BY: �g44LINJ
SC,. FOR LOCATION:
DAY INSPEC. NEEDED P TIME: -12-Q
�i 9
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. CIO/ ) ( ) FOOTING DRAIN
( } EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 4: —(o TIME: �� D O INS
CONTRACTOR: WEATHER: L
WORK INPROGRESS: aa4f
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: