HomeMy WebLinkAboutDrain Layers Permit 60 Rugby Lane WINDSOR TOWN OF SOUTH
DEPARTMENT OF PUBLIC WORKS `
• BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6145
Pursuant to writte'ii application, permission is hereby granted to the
Licensed Drain Wer Asme4 he/ � �
rein to perform the work indi a ed. belowat ---�"
v `QftQ_at pr m es owned by
df/ �
whose addres.s is and to
Lay House Drain, Repair Hous Drain, Lay .Main, Other ,
for occupancy or use, with
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
3,. SPECIAL CONDITIONS
Desired Starting Date Estimated, Time for Completion
Permit to be issued to `+
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
License Drain Layer
The above name Drai ay as valid license issued by the. State of
Connecticut and ha ile s€ ory bond and insurance .policy In .the
name of the Town o Sou W so
zA_4_;12
Engineering Dept. J. Date
Permit Fee Paid Check Number �39�
Connection Charge Receipt,. . Dated 2-0,9,-
i
Issued by
INSPECTION
Date work ` started t 21 Date completed
Sufficient notificaci n rece vim: Z.. des No
Special Conditions
Wit
APPR '�--
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
Q INSPECTION REQUEST
DATE OF REQUEST: -- ro— 7 5L TIME:
BY:
4,4"
FOR LOCATION: �b
DAY INSPEC. NEEDED 7— gq 94 TIME:
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT NO. 614-5 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE:. TIME: ® INSP:
CONTRACTOR: WEATHER: afi Cam(
WORK IN PROGRESS.
e
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: