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HomeMy WebLinkAboutDrain Layers Permit 40 Rugby Lane (2) TOWN OF SOUTH WINDSOR j DEPARTMENT OF PUBLIC WORKS j� BUREAU OF POLLUTION CONTROL flo 5816 DRAIN LAYER S PERMIT19 suant o written application, permission is hereby granted to the L Dra"n Layer named herein to perform the workindicated below at L at premises owned by �i(!/>� l i�L cor1s'ess, is '7 6 O' and to Le Drain, _ /Repair ,House Drain, Lay Main, Other , for y' occupancy Family Units , with acres. Type of Sewage to be connected and this permit : SANIT RY SEWAGE INDUSTRIAL WASTES { ) , OR ( ) Connection will be made with Show sketch of proposed work or furnis wo (2) copies of sep rate drawings. SPECIAL CONDITIONS Desired -Starting Date Est mated Time for Co mpl ion Permit to be issu d to the holder of Drain Lay r,s icense No. Per t will expire thirty 00) days after date of issues ce. The' und rsigned Dr n Layer hereby agrees to all the terms and con' itio s set forth in the pe it :an:d the reverse side thereof . pplicant has ceiv d' 'Town Per it No: - and/or CHD_ Permit - a Sign d Licensed Drain Layer The above name Drain ayer has a Va id license issued by the State of Connecticut and has .f' ed a atisfactor bond and insurance policy in the name of the Town of 'So. Win sor Iffy 3-9 Z. Engineering Dept. Date Permit Fee Paid $ -"" Check Number Connection Charge Receipt No. Dated Issued by INSPECTION Date work started Date completed Sufficient notificatlon rece ve : Yes No Special Conditions APPROVED: Inspector Date t TOWN OF SOUTH WINDSOR SANITARY SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: S�7dh/ BUILDING ADDRESS OR LOT N° : L8 f STREET: SUBDIVISION: (fiX04_/ Ee 0 W STATION : + NORTH ARROW INVERT ELEV: TIE TIE -FT -FT. HOUSE __ LATERAL LATERAL HOUSE CONNECTION STUB STUB CONNECTION FT. _ FT. BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING (IF F (I F EXIST.) TIE TIE Mi STATION : t INVERTELEV: CONTRACTOR (PRINT) NAME OF CONTRACTORS S RVISOR(PRINT) STREET ADDRESS SIGNATURE DATE -5 6�-1 11 iJJ S ow �' ©�O 7K TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER