HomeMy WebLinkAboutDrain Layers Permit 67 Ridgefield Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT6 w 5504
6 19 Xr
Pursuant to written application, permission is h re _granted to t1E Licensed Drain Layer
named herein to perform the work, indicated belpw at ,�rlG�`Uw
at premises owned by .4t1C�J�/ ' e--,,b �T, 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 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.
1
SPECIAL CONDITIONS
-
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License 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.
Signed
icensed'rrain 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 Department Date
Connection Charge Paid Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION 99
Date work started Date completed
Sufficient notification received: es No
Special Conditions
APPROV
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' : a
d
STREET:
SUBDIVISION: xt
Phi STATION : +
NORTH ARROW INVERT ELEV: '� .�r p
7.3
TIE TIE
FT -FT
HOUSE LATERALt LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. FT.
BUILDING INV. ELEV. INV.ELEV. 1= INV. ELEV. INV. ELEV.
(IF EXIST.) 4' BUILDING
(IF EXIST.)
I
TIE TIE
NH STATION : +
INVERT ELEV: JAf
VA r-", xJ
un!Le'l �,_;e j
AO-r
CONTRA TOR (P `I T) NAME OF CONTRACTORS VISOR(PRINT)
STREET�ADDR SS SIG TURE DATE
TOWN ATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER