HomeMy WebLinkAboutDrain Layers Permit 60 Scantic Meadow Ro TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT d`12 5-0 0
/`l 2
19 ;
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by whose address is
and to
Lay House Drain, V" Repair House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (C 7, INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer's License No¢r ; c:Y/�> 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 satisfactory bond and insurance policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid r�15 Sr Permit Fee: Paid $
/0 -I- to Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: l
Inspector p to
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TOWN OF 8-60 'H . WINDSOR
"SANITARY SEWER LA T' AL- FIELD LOCA1 ON
DATE OF CONSTRUCTION: 9r'!
BpI� NG ADDRESS OR LOT N': RD
C M
STREET:
SUBDIVISION:
Ni STATION : +
ORTH ARROW — INVERT ELEV:
ti
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TIE
7 F T.
F To
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S,. t AL R s-. H
OU OUSE STUB. 7,STUB CONNECTION
FT.
ILDING INV. ELEV. INV.ELEV INV. ELEV, INV. ELEV. BUILDING
EXIST.) (IF EXIST.)
TIE TIE
Mi STATION :—,+
INVERT ELEV:
RACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR(PRINT)
T ADDRESS SIGNATURE PATE
Jcr
f.,
STATE ZIP INSPSrTE /BY ,TOWS DATE
HONE NUMBER
—TOWN PINK —CONTRACTOR YELLOW —CONSULTING ENGINEER/DEVELOPER
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
05�
I
4\-7 ',:I s /
DATE OF CONSTRUCTION: /
BUILDING ADDRESS OR LOT N':
STREET:
SUBDIVISION:
t
71- AM STATION : +
NORTH ARROW INVERT ELEV:
TIE TIE
_FT _FT
HOUSE__.jr
_____ LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
U.
(IF EXIST.) (IF EXIST.)
TIE TIE
Mi STATION : +
INVERTELEV:
CONTRAtTTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
12
STREET
/ADDRESS SIGNATUR DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
(2e 2y26110
LEPHONE NUMBER
E - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER