HomeMy WebLinkAboutDrain Layers Permit 46 Ronda Drive TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 62$7
G " / 19 ?S
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
_.. �b ZA- at pre ises owned byoh.� a e ((Ra
whose address is and to
Lay House Dra+in, �/ Repair House Drain, Lay Main, Other
for _ ez� t .. / occupancy or use, with ,
Family Units , with acres .
Type of Sewage to be connected under this permit : SANITARY SEWAGE
INDUSTRIAL. WASTES ( ) , OR ( )
r Connection will be made withf�.V,c,
Show sketch of proposed work or furnish two (2) ` copies of separate drawings .
OSHA REQUIIZEMENOTS MUST BE FOLLOWED
SPBC1 CONDITIONS
Desire St tifi,ting Date �t -Q EstiMtTime for ompletion
Permit; t,o be issued to .
the holder .of Drain Layer 's License No . Pgo& /gcp Permit will e ire thirty
( 30.) days after date of issuance. The undersigned Drain Layer here agrees
to all t:he terms and conditions set forth in the permit and the rever side
thereof . App icant has received Town Permit No, and/or
CHID Permit N6o .
- -- Signed
Licensed Drain 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 $ _a5.40 Check Number/
Connection Charge Receipt No.. _61q-1 Dated
Issued by
INSPECTION
Date work started ��� -�� Date completed 6 -/b/-9
Sufficient notification rece ve .. yes No
Special Conditions
APPROVE
Inspebtor Date
SANITARY LATERAL.& .EXCAVATION-PEMM1
INSPECTION REQUEST
DATE" OF REQUEST: TIME:
BY: FOR LOCATION:
i ;DAY :INSPEC. NEEDED TIME:
TYPE. OF"INSPECTION: _ "
t S.MITARYfLATF1�P T:'` ERL�FTT' NO:: �Cj Z> 87 FOQ,TlNG- DRAIN:<..,
( j EXCAVATION (PERMIT. NO., ) ( ) OTHER-
i
INSPECT 0M.�F�EPOKT.
i DATE.: 1 '' TIME: .30
M00 INSP:
r CONTRACTOR:: .
WORK. IN: PROGRESS
Bj
<<' o o
n
d oe
AREA OF CONCERN:
• SPECIAL INSTRUCTIONS: