HomeMy WebLinkAboutDrain Layers Permit 56 Robert Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERM R
IT 6009
Pursuant to written application, permission is hereby granted to the
Licensed Dja�jn �jayer named herein to perform the -w-ork indicated below at
5r,31bh� r"t' Cl�/' at premises owned by. G Z• )
whose ,-Address is <i:nnix-- and to
Lay House rai , Repair ouse Drain, Lay Main, Other ,
for r 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 Clef
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
3 QUIREMENTS MU T BE FQjuL0 D
SP= ITIONCONDS do ARA
AA
Desired Start ing Date 2 c p
8 Es mate Time for Completion__,2Ljq&
Permit to be issued to
the holder of Drain Layer's License No ermit will expire thirty
(30) d`ays 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 i
licensed rain Layer
The above named Drain Layer has a valid icense issued by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
--�-3
Engineering Dept. Date
Permit Fee Paid $ oq , 00 Check Number <,Cs^L�
Connection Charge Receipt No. Qk ,S0 Dated c -j`-SI"2,,
Issued by
INSPECTION
Date work started Date completed
Sufficient notification rece ve : Yes No
Special Conditions
APPROVED:
Inspect r Date
i ,�
r
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: -si ?\?
BUILDING ADDRESS OR LOT N':
STREET:
SUBDIVISION:
_ft_ .
NH STATION : +
N
F_
NSRTH ARROW INVERT ELEV:
G 0'
aw" Lc,,krep ,S
Lo�
-TIE TIE
r
—FT \ —FT,
HOUSE LATERAL LATERALNOUSE
CONNECTION 17
�j cJ?STUB STUB CONNECTION
FT. / / FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) (IFEXIST.)
TIE TIE
W STATION : +
�' INVERTELEV:
fig 5 ►'Yr�fi x vGr, .� i'G
CONTRACTOR (PRINT) NAME OF CONTRACT ReS SUPERVISOR(PRINT)
(v 7� sv1 ,�-V�h - ! z - ��
STREET ADDRESS S ATURE DATE
—s2-,_W)I%vj S Df- 04—o 71
TOWN STATE ZIP INSPECTED BY TOWN DATE
) Jgq 6U 1
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW —CONSULTING ENGINEER/DEVELOPER