HomeMy WebLinkAboutDrain Layers Permit 115 Ridgefield Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 6040
Pursuant to w ten application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
at premises owned byi9Cf�//fib
whose address is if cr 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 (A) ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with
Show sketch' of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED d�r� ;t Tel
SPECIAL CONDITIONS
Desired Starting Date / Estimated Time for Completion .�
Permit to be issued to Kwwr e Y e0oY
the holder of Drain Layer's License No. �,7 ,� 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.
Signed
Licensed ayes
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:
En i eeri Dept• Date
Permit Fee Paid $ �iU%1 Check Nub er P
Connection Charge Receipt No. Dated ► .
Issued by/
l
INSPECTION
Date work started .. ,3 Date completed_
Sufficient notifica receive ; -Tes No --
Special Conditions
AP P e
nspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:
BY: FOR LOCATION: //.
DAY INSPEC NEEDED TIME: ,
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. 6 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 4t - - TIME: 0 t7 INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRES :
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: