HomeMy WebLinkAboutDrain Layers Permit 136 Rimfield Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6047
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Pursuant to written application, permission is hereby granted to the
Lice n ed Drain LAVAIr d herein to perform the work indicated below at
na �S at grem
nam Ises owz�}}ed by � T Lo/�L
w ose address is 6 ' an o" p/5-a - d to
Lay House Drain, Repai House Drain, Lay Main, gther ,
for occupancy or use, with �� the
Family nits, with acres. —� .
Type- of Sewage to be connected under this permit : SANITARY SEWAGE ( ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with D „ �
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUI E TS MUST BE POLLQWED
SPECIAL CONDITIONS j7� 7-v1 t�I"�'
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. ,`ram 30 . 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
ic4 sed D in 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 $ 2 S O O Check Number
Connection Charge Receipt No. �- � Dated /Q
Issued by 4;�4
INSPECTION
Date work started Date completed
Sufficient notification rece ve : es No
Special Conditions
APPROVED:
Inspector Date
SANITARY LATER L & EXCAVATION PERMIT
4)01--/-14/ INSPF-CTION REQUEST
.�y
DATE OF REQUEST: TIME: 6�S
BY: FOR LOCATION:
DAY INSPEC. NEEDED�l - 1 � TIME:
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. ) ( �) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: - ( TIME: ZQ 'Q O _ 3, 70 INSP:
CONTRACTOR: WEATHER:
WORK IN PRO ESS:
d4-
r
e
AREA OF CONCERN.:
SPECIAL INSTRUCTIONS: