HomeMy WebLinkAboutDrain Layers Permit 135 Robert Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT w
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by whose address is
and to
Lay House Drain, Repaiy House Drain, Lay Main, Other ,
for C ,h � i�,,- i< occupancy or use, with
Family Units, with 1 'acres.'
Type of Sewage to be corm,,%c ted 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.
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SPECIAL CONDITIONS 691
Desired Starting Date F J -- U Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No. 0,, - G qj ,, .. Permit will expire thirty (30) da s
Y
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. Applic, I s eceived
Town Permit No. and/or CHD Permit No.
Signed
L' ce sed Drain Layer
The above named Drain Layer has a valid license issued by the State Connecticut and
has filed a satisfactory bond and insurance policy in the name of the Tow -of South Windsor:
Engineering Department Date
Connection Charge Paid %' Permit Fee: Paid $ --6
Check Number F:
Issued by
Tax Office
INSPECTION � e-) �
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: t/ 02 D
BUILDING ADDRESS OR LOT N':
STREET:
SUBDIVISION:
NH STATION : +
i
NORTH ARROW INVERT ELEV:
TIE TIE
_FT _FT.
HOUSE.' `7
LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. FT
BUILDING INV. ELEV. INV. INV. ELE INV. ELEV. gUlLD1NG ,
(IF EXIST.)
(IF EXIST
Z�
TIE TIE
NH STATION : +
'T),=- MVERT ELEV: aJQ • V
C - ale Q 1-,l! e r-
CONTRACTOR (PRINT) NAME OF CO NT CTOR'S SUPERVISOR(PRINT)
�• 0 13# L- s- l r /I-V ' k�Z,2�1,9,d
STREET ADDRESS SIGN UR DATE
S. W , ►�1 s,N C-�- 06071f,`
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER