HomeMy WebLinkAboutDrain Layers Permit 19 Stoughton Drive TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 56 4 11-',
l S"bu . r r , 7 -` , 19
Pursuant to writte application, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at
at premises owned by ib; �1 ,�rt <<ti;yv whose address is
!�4 rr'�n� 71 � and to
Lay House Drain, Rep-dir House Drain, Lay Main, Other ,
for occupancy or use, with
Family Units, with acres.
Type of Sewage to be connected under this ,
YP g . permit: �SAI�ITARY'SEWAGE , Il�bi�STR L
.� .. TtA
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
1-9
SPECIAL CONDITIONS
Desired Starting Date `,'` ��' Estimated Time for Completion
Permit to be issued to :' 14�,�,r, -rror
the holder of Drain Layer's License No. .j?�rf�7 Permit will expire thirty (30) days
Y
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
Licensed Drain 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 ttj�e name of the Town of South.Windsor:
Engine rig Department bate
Connection Charge Paid-�Ff !!Vo`"/%' Permit Fee: Paid $
(- Check Number �Jonc''"
Issued by
Tax Office
INSPECTION
Date work started - g Date completed 249 —g
Sufficient notification recei ed: / Yes No
Special Conditions
APPROVED:
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N' :
STREET: 7�Q
SUBDIVISION: ,h wog(`
NH STATION : S
NORTH ARROW INVERT ELEV:
� I Sal 5
TIE TIE
-FT -FT.
HOUSE LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
FT. 13q°C FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) Y (IF EXIST.)
TIE TIE
W STATION : I�H +_�
INVERT ELEV: / 4 3°5
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
/b A e l Po,se, �._ 4
STREET ADDRESS SIGNATURE DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
Z03 )
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER