HomeMy WebLinkAboutDrain Layers Permit 9 Honeysuckle Lane i
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO ��700 F=
- 199"�,
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
�_G J, A:� C-, at premises owned by rat-, po M�; Ic1ek-S
whose address is 2CQ Lk-N—_ fz:L _ _-ci ,,ya ` 4-- )-J.nK_,_�ic-L-\ c and to
Lay House Drain, Repair House Drain, Lay Main, Othery`,
for occupancy or use, with
Family Units , with acres .
Type of Sewage to be connected under this permit : SANITARY SEWAGE
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 U „ 0 C'1>rs�Cc)CA-V2)1 , (2c, _
the holder of Drain Layer ' s License No . g(y Z e12 . 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 Dept . Date
Permit Fee Paid $ Check Number oan ayyA < ��
Connection Charge Receipt No . Dated
Issued by
INSPECTION
Date work started Date completed
Sufficient notification received : es No
Special Conditions
01
APPROVED-
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: fp-tf—°t l
BUILDING ADDRESS OR LOT N` : d.�
STREET: fln oi(eY 5mLl(L LANE
SUBDIVISION: Tf=gCh3�jP�D�KE
AM STATION :
NORTH ARROW INVERTELEV: l'LCa•�4{
,N r
�7q.0
129
TIE 9 TIE
FT. FL
HOUSE _ ___ LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. ( �Z' FT.
BUILDING INV. ELEV. INV.ELEV. I-; INV. ELEV. INV. ELEV.
BUILDING
(IF EXIST.) (IF EXIST.)
f
�Ifi.'1S
TIE TIE
7'2 �r L 3.z9a
tui),G CAT=Itj.2Z Mi STATION : I
Cs�w� 3c c,,=e59. �
g;Z s�� II�i° INVERT ELEV: f f w •2-
QOmpoo,CONS)'.
CONTRACTOR (PRINT) NAME OF CONTRA C ORBS SUPERVISOR (PRINT)
Cs 1 �ixf' mr c G�act E 1-7a WA- AID,
STREET.ADDRESS Q;E DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
( 7�03 ) 5Z6--�3z3 /
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER