HomeMy WebLinkAboutDrain Layers Permit 479 Rye Street TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMITNO 6279
Pursuant to written application, permission is hereby granted to the
Licensed Drain La er, named herein to perform the work indicated below at
dr e 9ss is Irewhose addre fl' at premises owned by
Lay House Drain, r/ Repair House Drain, Lay Main, Other and to
for occupancy or use, with
Family Units , with acres .
Type of Sewage to be. connected under this permit : SANITARY SEWAGE (�•Y INDUSTRIAL .WASTES ( ) , OR ( )
Connection. will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
6-s
Sea,t.r
r"S �r OSHA REQUIREMENTS `,MUST BE FOLLOWED
Desired Starting Date Estimated Time for 'Completion
Permit to be issued to �hCo/tie!lie►J C'ak
the holder of Drain Layer" s License No. o7z) Rd 97 - 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 Layer
The above named Drain Layer has a valid license issued by the State of
Connecticut and . has filed a satiq_f.actory bond and insurance policy in the
name of the Town of South Windsor :*
/3
Engineering Dept, Date
Permit Fee Paid $ Z-5� Check Number
Connection Charge Receipt No. Dated
Issued by i
INSPECTION:
Date work started Date completed
Sufficient notificTion receive : es No
Special Conditions
t
APPROV =�
Inspector Date
1
� JH/VI /HRL Wt CRHL 6C C/\VHYH1IVIV 1''CKM1 1
INSPECTION REQUEST
DATE. OF:'REQUEST: ,5 j0 TIME:
i�.,• BY: - Ct FOR LOCATION: Z
DAY .INSPEC. NEEDED TIME: l� •LU
TYPE' OF .INSPECTION:
�ANTTARY LATERAL; FERMIT,NO<:
(.. . (: Z 7 } •(.:. . }��. ..FOO:TING::DRAIN.:. ,
( ) EXCAVATION (PERMIT, NO. } ( } OTHER
INSPECTIOWR:EPOFM
DATE: ' 3��. 9S TIME: 9 �d _.. o INSP:
a
C`ONTRACTQIfi -u t_d�.1�,. :4!/
WORK- IN PROGRESS.:
auazz J.&dL .
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: