HomeMy WebLinkAboutDrain Layers Permit 15 Rugby Lane e
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO 6.255
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Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indi.catsd below at
jf�LA C O r at premises owned by
whose address is t / and to
Lay House Drain, Repair Ho se Drain, Lay Main, Other
for occupancy or use , with S it �iGF
Family Units , 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 BE FOLLOWED
SPECIAL CONDITIONS
.Desired Starting Date y Estimated Time for Completion Q S-'"
Permit to be issued to '
the holder of Drain Layer ' s License o. F 53 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
Signed ��'l�i'Gli �2 0&1f, �
Licensed Drain Layer
The above named Drain Layer -has a valid license issued by the State of
r Connecticut and . has filed a satisfact ry bond and insurance policy in the
name -of the Town of South Windsor :
ngie
Dept . Date
- Permit Fee Paid $ 2S-o6 yChe Num
Connection Charge Receipt No 4-S`38 1pated 4-4-1r
Issued by
INSPECTION
Date work started ' Date completed
Sufficient notification rece Tie` : es No
Special Conditions
APPROVED: 4"p 9��,`
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: I TIME:
BY: L 5�= FOR LOCATION: *V'r- 44aq 60a&-
DAY INSPEC. NEEDED ' �J¢l cJ TIME: 4EA OVA) --
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. IJZ ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: �-Otf—Qj�� • TIME: /"C�U INSP: �
CONTRACTOR: /G eo L.'fl WEATHER: /y
WORK IN PROGRESS: �iy� / Zvi ST�1-/Co/f7 L/h/�� r �� /���✓�`'''
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: