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HomeMy WebLinkAboutDrain Layers Permit 168 Rimfield Drive TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT N 2 6104 Pursuant to written application, permission is hereby granted to the Licensed Drain Layer :famed h rain to perform the work indicated below at at premi essowne by ,�"/—,7 Q�S� whose address is rig' o a to Lay House Drain, Repair Huse Drain, Lay Main, Other � for occupancy or use, with Family Unit-a,',' 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. OSHA REQUIREMENTS MUST E FOLLO ED SPECIAL CONDITIONS C/J s .�O ,�lcs/ , Desired Starting Date — a 5;e Estimated Time for Completion Permit to be issued Ito :QAA' ,T Gn y&-j holder of Drain Layervs License No. ZC2,gtjoe Permit will expire thirty 0) days after date of is-suance. The undersigned Drain Layer hereby agrees to all the terms and conditions set . forth in the permit and the reverse side thereof . Applicant hasreceived Town Permit No. and/or CHD Permit No. :.._;, Sig n e 0 2�. -0 ice dred Layer The above named Drain Layer has a va d lice a isy the State of- Connecticut and has filed a satisfactory bond and insurance policy in the name of the-.Town of South Windsor: ngineering Dept. v Date Permit Fee Paid $ ��.U�1' Check Number Connection" Charge Receipt No. _J�g, Dated r Issued by INSPECTION Date work started -�z�1�� Date completed -zZ 54 Sufficient notification re.ce ve es No Special Conditions APPROVED: Inspector Date SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST:- / `�- 9 TIME:_'Za © 0 BY: FOR LOCATION: '# (/1 DAY INSPEC. NEEDED TIME:� �/� , TYPE OF INSPECTION: ( SANITARY/LATERAL (PERMIT NO. 6 0 ) ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE: �p ' 22'i�-� TIME: INSP: CONTRACTOR: C/�i, WEATHER: WORK IN PROGRESS: //�/S j am/ �-r7� ,�✓��// -- /A- t--; G13 AREA OF CONCERN: SPECIAL INSTRUCTIONS: