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HomeMy WebLinkAboutDrain Layers Permit 20 Sele Drive TOWN OF SOUTH WI N DSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT 6194 199`4 Pursuant to written application, permission is hereby granted to the Li ensed Drain Layer named herein to perform the work indicated below at T C—Lt 1L at premises owned by r whose address is r _1zkj ) and to Lay House Drain, 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 �YQ , INDUSTRIAL WASTES ( ) , OR ( ) Connection will be made with Show sketch of proposed work or furnish 'two (2) copies of separate drawings. �oJ wa�.�roa OSHA WIREMENTS MO T BE TOLL ED SPECIAL C.ONDITIO y D Desired St t ng Date 4V Estimate:++ Time for Completion: Permit to be issued to the holder of Drain Layer's License No. Permit will expire thirty (30) days after- da.te of issuance. The undersigned Drain Layer hereby agrees ' to all the terms -and conditions set forth the perm t and: the reverse side _-,,:thereof. Applicaa �as received Town Permit o. an /or .. CHD Permit No. �� t�}� Signed censednraiV Layer; The above named Drain Layer has a v id license issued by the- State of Connecticut and has `filed a satisfactory bond and insurance policy . in the name of the Town of Sou'th 'Windsor: n in ng Dept. Date Permit Fee Paid $ � .0� Chec umber , ��� P - /�/9 Connection Charge Receipt No. ated' d-5-gy Issued by. lJ INSPECTION Date work started 0- ate completed Sufficient notificat on rece'lve es No Special Conditions APPROVED: Inspector Date SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: �D �S- 9 t�. TIME: 1 BY: �J FOR LOCATION: ur DAY INSPEC. NEEDED 10 - 6 - 9� 4- TIME: TYPE OF INSPECTION: D�s�7- L 9 2- 1044 7 6 ► 93 � 1,,, ( ) SANITARY/LATERAL (PERMIT NO. fp/� ¢- �S ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER / INSPECTION REPORT DATE: l © --Cp �- TIME: r 0 INSP CONTRACTOR:- ,�} �,, WEATHER: s WORK IN PROGRESS: r Syr 4 JAqa� id �r 5: ozi/ ' r AREA OF CONCERN: SPECIAL INSTRUCTIONS: