HomeMy WebLinkAboutDrain Layers Permit 107 Ridgefield Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 6085
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Pursuant to w i n application,pp . cation, . permission is hereby granted to the
icensed Drain Layer 10amed herein to perform the work indicated below at
�--03 •'el t premises owned by
whose address is p, and to
Lay House Drain, _} _Repair House Drain, Lay Main, Other
for occupancy or use, with �
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) copies of separate drawings,
i
i
i
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Date
8 / Estimated Time for Completion
Desired Startin
Permit to be issued to
the holder of Drain Layer's Lic se No ,,d +& Fermi 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.
Signed
Licensed Dr 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:
*7
Engineering Dept. Date
Permit Fee Paid $ Check Number �j}-�.
Connection Charge Receipt No. f,'` Goo, OU Dated c?-7- 9.4-/
Issued by
INSPECTION
Date work started � � Date completed 5'�
Sufficient notification race ve : es No
Special Conditions
APPROVED: /0-2179
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
14
INSPECTION REQUEST
DATE OF REQUEST: 2j-\-I TIME:
Q3 �
Lo
BY: Leo c g e ��*T FOR LOCATION: L v 5--1
DAY INSPEC. NEEDED TIME: jj.30 Aryl
TYPE OF INSPECTION:
V) SANITARY/LATERAL (PERMIT NO.6o 6 c/ ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
f'/�v�i�Gy Do;� v�3 ®•v �21�sv �igy
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
TOWN OF SOUTH WINDSOR
• SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N° : Lr' �3
STREET: e--1 1 e/4/.00?1 e!
SUBDIVISION:
MH STATION :
NORTH ARROW INVERT ELEV:
63�
TIE TIE
-FT -FT.
HOUSE '
__ __ LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
6a FT. Z Zlolo.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.)
(IF EXIST.)
l�
TIE TIE
Ni STATION : /Z- +�
INVERTELEV: Z(Q8•o
c - 6 M.
ierwrAf-
CON RACTO PRINT) NAME OF C NTRACTOR'S PERVISOR(PRINT)
/?0
STREET ADDRESS SIGNATURE DATE
as I/X` (? : 04 03
TOWN STATE ZIP INSPECTED BY TOWN DATE
(&U ) �Ivlv9
TELEPHONE NUMBER
WHITE -TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER