HomeMy WebLinkAboutDrain Layers Permit 102 Spinners Run TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6116
.
Pursuant to written application,, permission is hereby granted to .the
Licensed Drain Layer named herein to perform the work indirc ed below a;t ,,
premises `o ned by
whose addre`s: and to
Lay House Dr 'in, e ai,,Fg rain, Lay. Main, Other ,
for _L � occupancy or use, with
Family Units, with res.
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.
l
OSHA REQUIREMENTS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
*01 It
Permit to be issued to
the holder of Drain Layer ' s License No. 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 ,rt-,hn reverse side
thereof . Applicant has received Town Permit No. nd�or
CHD Permit No.
Signed' G%
icensed rain I& ter-
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 the Town of South Windsor:
f Eng neering Dept. Date
nczll
Permit Fee Paid $ v Check Number
Connection Charge Receipt No. •�� Dated
Issued by
INSPECTION
Date work started 50 - Date completed 5-
Sufficient notification r ce e : _Yes No
Special Conditions
F Of
APPROVED: l/ -
nspector Date
TOWN OF SOUTH WINDSOR
.SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N° : _ /7 Ao, S tort►
tv STREET:
SUBDIVISION:
NH STATION : +
NORTH ARROW INVERT ELEV:
%3ci f
TIE Al J TIE
c
-FT -FT.
HOUSE Air `Ih MOUSE
LATERA LATERAL _
CONNECTION STUB STUB CONNECTION
FT. ::LEILEV.
� r FT.
BUILDING INV. ELEV. INV.ELEV. 1- INV. ELEV. INV.
(IF EXIST.) BUILDING
(IF EXIST.)
TIE TIE
Mi STATION : +
INVERTELEV:
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
y / .r ,t, jr /
STREET ADD E S SIGNAT RE DATE
TOWN STATE ZIP INSPECTED 8Y TOWN IfATE
` 74e3llq 7:
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER
`163-zo40
SANITARY LATERAL & EXCAVATION PERMIT
q36 -1,560 CTruck>
INSPECTION REQUEST
DATE OF REQUEST: p�,� \\ TIME: goo
BY: �� ��g� FOR LOCATION:
DAY INSPEC. NEEDED .Sl��l�y TIME:
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. ) ( FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: - TIME: / "G a INSP:
CONTRACTOR: (#-.4 ) WEATHER: 0'", O o �
WORK IN PROGRESS:
f f ,V 1 c r�
r f ,
Ila ft,� 04, t Z:2(te
N
e
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
' SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:
BY: / FOR LOCATION:
DAY INSPEC. NEEDED // �I TIME:
TYPE OF INSPECTION:
( n) SANITARY/LATERAL (PERMIT NO. �O 1161 ) ( ) FOOTING DRAIN
( } EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: - TIME: , 3 INSP:
CONTRACTOR: gha WEATHER: m �
WORK IN PROGRESS:
r
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: