HomeMy WebLinkAboutDrain Layers Permit 28 Rugby Lane TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 6068
/7 , 19 3
Pursuant to written application, permission is hereby granted to the
Lice s d Drain Layer named herein to perform the work indicat d below t
_,66at premises owned by -i/Ji _
hose addres isa. /. e7 and to
Lay House Drain, Repair House brain, Lay Main, Other ,
for occupancy or use, with j
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.
L.o � cl OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting bate Estim ed Time for Completion
Permit to be issued to Aw the holder of Drain Layer's License No. 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 No.
Signed
Licensed Drain , aver
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: /n „,,�
Engineering Dept. Date
Permit Fee Paid $ 7
,!`� `--
Check Number l�hr
Connection Charge Receipt No. 4at1{0(;p Dated ;
Issued by
INSPECTION
Date work started /,� �� �9, Date completed
Sufficient notification ecelve : - Z.-Yes No
Special Conditions
APPROVE 12-
Inspector Date
s
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: J 2, - Z 2 ' 9 3 TIME: �7 ; 30
BY: " # G4�/J.dl� FOR LOCATION: 41t otfi4
DAY INSPEC. NEEDED Z TIME:
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. 00 6 ) ( } FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 9 TIME: JQ;06 - `. a INSP:
CONTRACTOR: UI&a CQ,(f� WEATHER: +
WORK IN PROGRESS: CL41
IL
-47
a
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: