HomeMy WebLinkAboutDrain Layers Permit 80 Ident Road (2) !� TOWN OF SOUTH WI N DSOR
` DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT J2 c3 0
19�i' 1
Pursuant to written application, permission is hereby ranted tp t e Licensed Drain Layer
named herein to perform th wor indicated below at U 4M r LPA4 f
at premises owned by whose address is
and to
Lay House Drain, ry(,. Repair s use Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this R
yp g permit: I�NITAR� Y SEW ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
t
!I' 1
SPECIAL CONDITIONS 1'"!�/'�
Desired Starting Date f Estimate . me for Completion
d E" j
Permit to be issued to �
AA-e-
the holder of Drain Layer's License No. Permit will expire thirty (30) days
after date of issuance. The undersigned Dra' 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 }� r7
Licensed Drain Layer
The above named Drain Layer has a valid license is"ed 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 ��� P Permit Fee: Paid $
Check Number
Issued by
Tax Office
INSPECTION /
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED: p,
1 Inspector ✓T pa'ttb
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' : �_� f,l /✓t- T
STREET:
SUBDIVISION:
0
W STATION : +
NORTH ARROW INVERT ELEV:
TIE TIE
FT LFT._'Y'lHOUSE � _ LATERAL ATER L _ AELEV.
HOUSE
CONNECTION � STU8 ST O NECTION
FT. FT.
BUILDING INV. ELE . INV.ELEV. � INV. ELEV. gUILDiNG
{if EXIST.) �A / / (IF EXIST.)
9
TIE TIE
AM STATION : t
7,VERT ELEV:
` 9�x r &Ac
�.
CONTRACTOR (PRINT) p� N E r CONTRACTORS SUPERVISOR(PRINT)
so
STFf EET ADDRESS SIG#TJ DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
_ 00 �\ � S_7-
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER
(CONNECTICUT) 06/07/91 15: 48: l-5
0
-J1 --r7G
03-SWSWINDS _T5 -CW
REQUEST NO. . 9iC3191g -T6 -GV
TOWN. . . . TIME. . 15: 45 DATE. . 06/07/gl
ADDRESS. , " ' SOUTH WINDSOR
NEAREST STREET DATE.
RD
. 80 IOENT RD GRID CODE„ K04C4
TYPE OF WORK, .
REMARKS, • „ INSTALL SEWER CONNECTION
CALLER. , . " WORKING FROM OPPOSITE SIDE/ST TO
AARON ADAMEC HSE. AIM
TITLE. . . . . . .
START DATE. , 06/12 START TIME. . 7: 30AM
PHONE #. . . . . 289-8589
CALL BACK. . , 8-5 CONTRACTOR. . AOAMEC CONST. (P
ADDRESS. . . . . 385 SCHOOL ST, EAST HARTFORO, CT 06108
EXCAVATOR DOING WORK- SAME
ISSUED TO:
DATE/TIME ARRIVED: DATE: TIME;
TIME LEFT: BY,
CALL BACK: 1 ) DATE: COMPLETED BY:
PERSON CONTACTED: TIME: BY: 2) DATE;
PERSON CONTACTED: TIME: BY:
7 l 1
f 15. ;�F