HomeMy WebLinkAboutDrain Layers Permit 108 Ridgefield Drive TOWN OF SOUTH WINDSOR
�. DEPARTMENT OF PUBLIC-WORKS
BUREAU OF 'POLLUTION CONTROL
DRAIN LAYERS PERMIT .. 156
Pursuant to writt6ap l cation ermi'ssion is hereby r
pP . , p _ .. y granted to the
Licensed Drain Lay6lr named herein to perform th.e work indicated below at
at premises owned by 1v9 ,,fAW gnn,
whose address is and to
Lay House ,Drain, Repair House Drain;, Lay Main, Other ,
for ,�,`' occupancy or use, with
Family Units , with ;acres.
Type of Sewfle to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL WAST,WS ( ) . R
�IConnectLon wiXbe made '-with
of Show sketch proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Estimated Time ,for Completion
Permit to be issued to
the holder of Drain Layer' s Lice se No. d� /7 Permit 11 ekpYre 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
Signed
c'issiv . s-s�/�
L cen a Drain Laye
The above named Drain Layer has a valid license issued. by. the State of
Connecticut and has filed a satisfactory bon and insurance policy in the
name of the Town of South Windsor:
Engineering Dept. Date
Permit Fee Paid $ ah'' Check Number
Connection Charge Receipt No, Dated
�bIssued by_ _ �.
INSPECTION
Date work started Date completed
Sufficient notificaE on receeive • des No
Special Conditions
APPROVED-- ,
7-2L:�T
Inspector Date
r SANITARY LATERAL & EXCAVATION PERMIT
E .
INSPECTION REQUEST
DATE OF REQUEST: 20� TIME: &A4,
BY:- FOR LOCATION:vr
DAY INSPEC. NEEDED Z�- �L TIME: tit
TYPE OF INSPECTION:
SANITARY/LATERAL (PERMIT NO.- [,5 6 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
/ INSPECTION REPORT
DATE: ! _ TIME: Z.L0 8 INSP:
CONTRACTOR: �7 WEATHER: �),C, q 5 0
WORK IN PROGRESS:
P
l
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: