HomeMy WebLinkAboutDrain Layers Permit 1 Tumblebrook Drive A t'
TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 2 6292
Pursuant to written application, permission is hereby g ant-ed to the
Licensed Drain .Layer f amed. herein to perform the work indicated below at
'�U:13 43 i22�k�f 122 at premises owned by (�1161Jf
whose address is 15;:A 41 et and to
Lay House Drain, �` Repair House Drain,_____Lay Main, Other
for occupancy or use, with
Family Units , with acres .`
Type of Sewa a to be connected under this (✓) �yP g permit : SANITARY SEWAGE
f INDUSTRIAL WASTES ( ) , OR (
Connection will be made with 6 -2
j Show sketch of proposed work or furnish two (2) copies of separate drawings .
O QUE IREMENTS MUST FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date Estimated Time for Completion
Permit. to be issued to C,,��Lp� C f,^,
the holder of Drain Layer ' s License No. �d �. Permit will expire thirty
( 30) days after date of issuance. The un ersigned Drain Layer hereby agrees
to all the terms and conditions set forth in the permit Rand/or
reverse side
thereof . AppliqslZ.900LW
nt has received. Town Permit No .
CHD Permit No .
Signed
cen ted 11 n er
The above named Drain Layer has a- valid li ense iss by the State of
Connecticut anl . has filed a satisfactory bond a d insurance policy in the
name of the Town of South Windsor :
A,)2
Engineering Deptt • -- Date -
Permit Fee Paid $ 0o Check Number
Connection Charge Receipt No. G292 Dated 6-22-QJ
Issued by &W
INSPECTION
Date work started Date Date completed
Sufficient notification received : Yes No
Special Conditions
APPROVED: l'/� la`ZT-
nspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE"OF REQUEST: TIME:
? 3a
BY: FOR LOCATION:
DAY INSPEC. NEEDED. \ o�S ��2'9 TIME: c)
TYPE OF INSPECTION:
x ( ) SANITARY LATERAL'- (PERMIT"No'.: FOOTING-:DRAIN, _.
( ) EXCAVATIONI (PERMIT. NO. ) ( ) OTHER
INSPE IOWREPORT: .
/.t ® o
TIME: :60 INSP:
S
CONTKACTOR::`. WEAT :' O n
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: