HomeMy WebLinkAboutDrain Layers Permit 93 Rugby Lane TOWN. OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
" 0 DRAIN LAYER'S PERMIT 5823�'
V�
&c2 / 199
Pursuant to written application, permission is hereby granted to the
License in
La a named herein to perform the work indicated below at
at premises owned by
whose address is and to
Lay House Drain, __Repair House Dr ftn4 Lay Main, Other ,
for occupancy or use, with
Family Units, with acres .
Type of Sewage to be connected under this permit : SANITARY SEWAGE (SQ ,
INDUSTRIAL WASTES ( ) , OR ( )
Connect ion will be made with TIZ i - S TJ9 7'LY X C g y 7-4- Z5 DR 35-
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS i AU.S7 PC
Desired Starting Date 771 97 9 -z- Estimated Time for Completion k I Z
Permit to be issued to ,P' sj`�g-y - t7-?f-C*cJf{'7De_5
i
the holder of Drain Layer ' s License No. 2C�Q G,.. 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 �lil
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 :
r� Engineering Dept. Date
Permit Fee Paid $ �7 �I Check Number
Connection Charge Receipt No. L- 2de Dated
Issued by
INSPECTION
Date work started 7/' Date completed
Sufficient notification recei-ve : —Yes No
Special Conditions
APPROVED:
In pect-or Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 15 7l
BUILDING ADDRESS OR LOT N' : ka ! 7
STREET: ift !,
SUBDIVISION: t p f}AO1,�J
w�S r a
co,�ti��z 0`
C�rGN rc3 sib Mi STATION : +
NORTH ARROW INVERT ELEV:
TIE TIE
-FT -FT,
HOUSE LATERAL FLAITILH _ HOUSE
CONNECTION STUBSTUB
CONNECTION
FT. ®�J FT.
BUILDING INV. ELEV. INV. INELEVU. . INV. ELEV. BUILDING
(IF EXIST.) (IF EXIST.)
TIE TIE
TATION : #
/'Yj/9N�OL INVERT ELEV:
'l fZ f YT f-!-e )E X _1-iv d_ jwl I P {w-v
CONTRACTOR (PRINT) AME OF CONTRACTORS SUPERVISOR(PRINT)
1
�'-9 0-/12
STREET-ADDRESS SIGNATURE DA E
TOWN STATE Z P INSPECTED BY TOWN DATE
( �S,70 �i-.!,- q 6 9 6
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER