HomeMy WebLinkAboutDrain Layers Permit 035 Austin Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
r BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 7 y 6078
19
Pursuant to written application, permission is hereby granted to the
Licegsed Drain Layer named herein to perform the work indicated below at
/V T '9 i at . remises owned by �j '/�/J- (on! -1
whose address is ' $ ! ! G �y� / -/ a to
Lay House Drain, Repair Hdilse Drain, Lay Main, Other
for 1 occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with SDR ai v�
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIREMENTS MUST E FODLOWED
SPECIAL CONDITIONS_(
Desired Starting Date 2_ -jg _9 rq Estimated Time for Completion / ,0092
Permit to be issued to ff:)h4 .)a C1420 tf-1S
the holder of Drain Layer's License No. Zogg,10 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
Llcen�)& Dr n 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
name of the Town of South Windsor:
Engineering Dept. Date
Permit Fee Paid Check Number 5 N 75
Connection Charge Receipt No. </t1/ y� Dated Z_ �Yy
Issued by
INSPECTION
Date work started ¢ - 7•- 9 L - Date completed
Sufficient notification' ece ve : Yes No
Special Conditions
APPROVED-, e #_ 4
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: �-r 9 TIME:—
BY: FOR LOCATION:
tv
DAY INSPEC. NEEDED wl124. /�. ��J� TIME:
TYPE OF INSPECTION:
( X) SANITARY/LATERAL (PERMIT NO. 7,4 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: / 7 9 t�- TIME: J/ 0 (J — Z;ODINSP:
CONTRACTOR: WEATHER: iCl 4
WORK IN PROGRESS: <�
J
/?M. 7Zo Wj)
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
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