HomeMy WebLinkAboutDrain Layers Permit 4 Honeysuckle Lane TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT NO 5693
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written application, permission is hereby granted to the Licensed Drain Layer
erform the work ind'cated below at 1�� } WotjW Ljp (_ ( Pe U 6C IdaA
by Ge0o'A g�xt �rC whose address is
n d f(.0 and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for / occupancy or use, with
Family Units, with acre .
Type of Sewage to a connected under this permit: SANITARY SEWAGE ( ), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
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Show sketch of proposed work furnish two (2) copies of separate drawings.
SPECIAL CONDITIONS
Desired Starting Date ii Est%A- cz
d Time for Completion
Permit to be issued to AOQiGt� 6 � r, f Cow\ CJp o"D ft)A uri
the holder of Drain Layer's License No. rmit will expire thirty (30) days
after date of issuance. The undersigned Drain Layer he eby agrees to all the terms and
conditions set forth in the permit and the reverse side ereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
icensed rain 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 th Town of South Windsor:
u Engineering Department Date
Connection Charge Pai 7�� Permit Fee: Paid $
d'
VA \"\C\\ a Check Number
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
TOWN OF SOUTH WINDSOR v \
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ,jo
BUILDING ADDRESS OR LOT N° : Aa
STREET: Honk;` c4"LE Lpt4j
SUBDIVISION: `7Cbi�C,
NH STATION : 1�_+
NORTH ARROW FLASTERAL
: �• �
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-FT -FT.
HOUSE LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. ��� FT.
BUILDING INV. ELEV. INV.ELEV. � INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) (IF EXIST.)
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IuJ att = t��.2Z *i . STATION : (j ♦ 6 0
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CONTRACTOR (PRINT) NAME F CONTRRA'CT RIS SUPERVISOR(PRINT)
STREET.ADDRESS SIGN DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
( 20-5 ) 52 S-7323 l S5 9—25 o[
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW —CONSULTING ENGINEER/DEVELOPER