HomeMy WebLinkAboutDrain Layers Permit 176 Smith Street (2) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1 65
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated,. el.ow a-t
ni at premises owned by - ►Ji...
whose address is M and to
Lay House Drain, x Repair House Drain, Lay Main., Other
for p �„9,ca Lr occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permits SANITARY SEWAGE (�) ,
INDUSTRIAL WASTES ( ) , -OR { )
Connection will be made with ' V L
Show sketch of proposed work r furnish 'two (2) co of separate drawings.
OSHA ,REQUI6EMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Start ing,Da e! Estimat. d Time for Completion
Permit Id "be issued to r
the holder o`f Drain Layer 's License No. Permit will expire thirty
(30) 'days after date _of issuance. The :un ersigned 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 I.A_A zi..._
icensed Drain Layer
- The above named Drain Layer has a val I license is-sued 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 $ 5 Check Number
Connection Charge Receipt No. Dated' d'0L '9'
Issued byy
INSPECTION
Date work . started /I'? Date completed 9111V
Sufficient notific-aT on receive'a: es _ No
Special Conditions
APPROVED: /7 •®oj ®��
Ins—' pector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF,REQUEST: �"�Jl � '7 TIME:
BY:_0/91�5 ��'-tJ �=� FOR LOCATION: le,
DAY INSPEC. NEEDEDZ Ota/ ,� TIME: t�
TYPE OF INSPECTION:
a
( ) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION {PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: , TIME: _ 9' 3y INSP:
CONTRACTOR WEATHER:
WORK IN PROGRESS
C.�a�✓ G/C vas U a &zU �Io i f��vi`S 'o' ��tg�
AREA OF CONCERN;
SPECIAL INSTRUCTIONS: