HomeMy WebLinkAboutDrain Layers Permit 70 Strong Road (2) � Id AV `' `�q TOWN OF SOUTH WINDSOR
q � gC� 6 DEPARTMENT OF PUBLIC WORKS �a
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5561
�.� 199�
Pursuant to written application, permission is hereby granted to the Licens d Drain Layer
named herein to perform the work indicated below at d ,
at remises owned by ose address is
h an to
Lay House Draij►, Repair House Drain, Lay Main, Other ,
for occupancy or use, wit
Family Units, with acres.
Type of Sewage to be connected under this PTiL SANITA SEWAGE , IND STRIAL
WASTES ( ), OR ( ) Conn tion wi 1 be de with
Show sketch of proposed work or furnish two (2) copie of separate dr ings.
SPECI CONDITIONS
Desired Starti Date -• Estimated Time for C mplet'on
Permit to be sued to bA A
the holder of Drain yer's License C f Permit will e pire thirty (30) days
after date of issuance. The undersi ne Drain Layer hereby agrees to all the terms and
conditions set forth in he permit a d t e reverse side thereof. pplicant has received
Town Permit No. and/or C Pe it No.
Signed
icensed Drain Layer
The abo-Ae,..named Drain Layer s a v lid license i by the State of Conn icut and
has filed a satisfactory bond and i uran e policy in the name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid 01 8 _ Permit Fee: Paid $
de q! (1/ Check Number
Issued by
Tax Office
INSPECTION;
Date a wo started Date completed
Sufficiq t notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: L
BUILDING ADDRESS OR LOT N° : 0 f
STREET: 57
SUBDIVISION:
W 1 STATION
NORTH ARROW INVERT ELEV: ( 3
TIE TEE
F_7F _FT
HOUSE _ i __ LATERAL I LATERAL HOUSE
tONh ECTION STUB STUB CONNECTION
FT. � Y .6
BU LDING V. ELEV. 1 V.ELEV. INV. ELEV. INV. ELEV. BUILDING
(t EXIST.) (IF EXIST.)
.� TIE TIE
bH STATION : 7 _+.15
INVERT ELEV: oil
CON-TRACTOR RE�ACTOR (PRINT) NAME F CONTRACTOR'S SUPERVISOR(PRINT)
, y
STREET ADDRESS SIG TURE
DOE
TOWN STATE IP INSPECTED BY TOWN DATE
( 003 ) 1; J_ 7-'0fcpS'
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER