HomeMy WebLinkAboutDrain Layers Permit 72 Spinners Run TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 6097
- -
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer n me herein to perform the work indic-ated elow at
- �S ,� ,-1 a pr m ses Pwned by ��� ;�a
whose address s � �( � and to
Lay House Drain, Repair Ho se Dra n, Lay Main, Other
for - occupancy or use, with
Family. Units, with acres.
s
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 OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date � )�R Estimated Time for Completion •`�, Z)
Permit to be issued to ��
the holder of Drain Layer's License No. -�y , ._.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 r� G1
Licensed Drain Layer
The above named Drain Layer has a valid license issued by the State of
G. Connecticut and has filed a satisfactory bond and insurance policy in the
F name of the Town of South Windsor:
Engineering Dept. Date
Permit Fee Paid Chuck Number
Connection Charge Receipt No. f, qz7 Dated
Issued by
INSPECTION
Date work started Date completed
Sufficient notifica on re e v ,J`yes No
Special Co itio
APPROVED:
Iffspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: J� '.30 - �1 TIME:
3�
BY: ��/y �GF?JG=�� FOR LOCATION:
DAY INSPEC. NEEDED J-3/ - TIME: Z
TYPE OF INSPECTION: / Q
( � ) SANITARY/LATERAL (PERMIT- NO. V/0 J ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
q
DATE: 3 - 51 - 2 ¢ TIME: / �`0 p r / 40 6 S INSP: yt
CONTRACTOR: WEATHER: OA, 350 +-
WORK IN PROGRESS: Lad
r
e
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: