HomeMy WebLinkAboutDrain Layers Permit Deming Street - Shar TOWN OF SOUTH W1 N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6300
G 191 �
T'-
Pursuant to written application, permission is hereby granted to the
Li�s�d Drain. Lay named herein to perform the work indicated below at
,�( c� � ' , C at r mises own;a
whose address is C' !e � l/ -f0� and to
Lay Ho Dr in, Repair Ho a Dr Lay Ma n, -Other ,
for �Si��/ ccupanc r use, with
Family Units , with acres.
Type of Sewage to be connected under this yp g permit : SANITARY SEWAGE ( ,
INDUSTRIAL WASTES :( ) ,' OR ( )
Connection will be made with
Show sketch of proposed worn or furnish two (2) copies of separate drawings .
�! e'i OUP' c' � �v/ k; GW 7`/ C
M 14 TWE- Peo.j T d A-)Ly-- M � try M YZ
L'i /L L P60 (. y s' REQUIR ENTS E FOLLOWED �
SPECIAL CONDITIONS egg, MUST� t�`(,(1/(L
Desired Starting Date Estimated Time for Completion /
Permit to be is ed to
the holder of Drain Layer ' s License No . 7
u Permit will expire thirty
( 30) days after date of issuance. The nd.e signed 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 tn. -__ and/or
CHD Permit No .
Signed
L censed 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
/;4 -
name of the Tower of South Windsor :
Engineering Dept . Date
Permit Fee Paid $ Z,�" Check Number 1 `4-
Connection Charge ReceiptNo . QIV (F LI
Issued by
INSPECTION
Date work startedDate completed
Sufficient _notification received : Yes No
Special Conditions
APPROVED:
Inspector Date
SANITARY LATERAL &,EXCAVATION PERMIT
INSPECTION REQUEST
► ` DATE OF REQUEST:. - f TIME:
BY: FOR LOCATION:
DAY INSPEC. NEEDED 5 TIME:
TYPE OF INSPECTION:
SANITARVLATERALZ (PERMIT`No--6360-0 ) ( } FOOTING-.DRAIN:.
EXCAVATION (PERMIT 'NO. ) ( } OTHER
FNSPECTION-RER0R-Tr
f DATE:: TIME: Z :D c� INSP:
n
CONTRACTOR: WEATHER,:.- :
7- /B-95
WORK IN PROGRESS•
-1p�
0
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: "