HomeMy WebLinkAboutDrain Layers Permit 75 Spinners Run TOWN OF SOUTH W!N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
�/ S� f �SJZ'Q�DRAIN LAYER'S PERMIT No .6169
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Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer named herein to perform the work indicated below at
SP�n�at , Rum. LoT stto at premises owned by s ?t4oMpso,�
whose address is. SAauwm.5 Qum Lot W(p and to
sHouse Drain - Re'pair House Drain, Lay Main, Other ,
for S occupancy or use, with
i
Family Units , witV acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ( ,
INDUSTRIAL WASTES - ( ) , OR { )
Connection will be made with PVC SD2 35 (0" PIPS
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
L° WAD
Nsw
wo 1RK.
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date g-S-94 Estimated Time for Completion
Permit to be issued to ZTAMe$ 'D. Acem
the holder of Drain Layer' s License No. ?OS-AS;r, 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
License Drain Layer
The above- named Drain Layer has a val icense issued by the, State of
Connecticut and has filed a satisfactor b nd and insurance .policy .in the
name of the Town of South Windsor
En ine - n.g Dept. Date
Permit Fee Paid $ ,0� Check umber 18()Q
Connection Charge, Receipt No. 16 Dated -5-� .
Issued by
INSPECTION
Date work started 8-a ,-GlL/ Date completed
Sufficient notificaf•ion receivea : Z.7 yes No
Special Conditions
APPROVED:
Inspector Date
`J SANITARY LATERAL. & EXCAVATION PERMIT
INSPECTION REQUEST
DATE /�►
OF REQUEST: �J �" TIME:
BY: �`IM EZ r FOR LOCATION: T 45,P^.40M &A.,
DAY .INSPEC. NEEDED 8.tv TIME:
TYPE OF INSPECTION:
( ✓'� SATARY/.LATERAL` (PERMIT NO, ) ( ) FO
NI QTIN.G DRAIN
( ) EXCAVATION ('PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: id�' g� , TIME:;, ti INSP.:. /�
CONTRACTOR:- /dGG--l-v WEATHER:
WORK IN,PROGRESS
t
AREA OF CONCERN:
�r
SPECIAL INSTRUCTIONS: