HomeMy WebLinkAboutDrain Layers Permit 9 Tuttle Circle TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 6290
19 S/
7Li�cenjsed,,Drain
o written application, permission is hereby granted to .the
Layer named herein to perform the work indicated below at
_LfZ_L 'r'G jz= at premis s owned by � Cy
whose address is �S` t., S' � a to
Lay House Dram}, Repair Ho gale Drain, Lay Main, Other
for fA07/14e occupancy or use, with S
Family Units , with - acre's .
Type of Sewage to be ,connected under this permit : SANITARY SEWAGE (`y
INDUSTRIAL WASTES ( ) , OR (
Connection will be made with . ./fJ�
Show sketch; of _proposed 'work or furnish two (2) copies of separate drawings .
OSHA REQUIREMENTS IJUST BE F L WED
SPECIAL CONDITIONS S EG- v 4 OC.PJ
Desired Starting Date Estimated Time for Completi-on�(,�9 �
Permit to be ;issued to �p h,/\ -33 t � oe-5
the holder of Drain Layer 's. License No. -a-0g'g31Q• 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
icens ra aver
The above named Drain Layer has- a val icense ssued y 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 $ C .dC? Check Number
Connection Charge Receipt No. Dated
Issued by �
INSPECTION
Date work started Date completed
Sufficient notification receive3 : Yes No
Special o n d i i n s
APPROVE -:re +2s'
nspector Date
SANITARY_LATERAL& EXCAVATION PERMIT
INSPECTION REQUEST'.
DATE OF ItEQi3ESTz f�lO'� �2Ev -�7 5 TIME: Z%�a
BY: L�YYJ FOR LOCATION I �a
DAY?'-INSPEC. NEEDED T(�G"' TIME:
:'TYPE OF INSPECTION*. '
(� y- SANIT,ARWLATE'R-AL-< (�PER�TT`-NO`_-; FOOTING.-:DRAIN...,
( ) EXCAVATION (PERMIT_NO. ) (` ) OTHER
INSPRECT[QWREPORT, .:
00,
DATE: TIME INSP:
CONTRACTOR --T WEATHER-
WORK IN PROGRESS:.
et_
0001
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: