HomeMy WebLinkAboutDrain Layers Permit 6 Tuttle Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N 6031
19
Pursuant to written application, ,permission is hereby granted to the
Licensed Drain Layer named h. rein to perform the work indicated below at
Lot 71 Tuttle Circle o.- at re ises owned by alO/ j �' cry,,Si
whose address is S o 7 d tq
Lay House Drain,, Repair Erouse Drain, Lay Main, Other ,
for m occupancy or use, with l
Family Units, w th 3 acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE
INDUSTRIAL WASTES ( ) , OR ( )
Connection will be made with S'b,p 3 5
Show sketch of proposed work or furnish 'two (2) copies of separate drawings.
OSHA REQUIPY44ENTS MUST BE FOLDOWED
SPECIAL . CONDITIONS e.
Desired Starting Date --27__ EstiqAted Time for ,Completion
Permit to be issued to �f� 4— c ��
the holder of Drain Layer's Lice a Nq�' ?_o{�r:�.3C7 . 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. ,
Signedt1�=---
Licen d Dr Layer
The above named Drain Layer has a valid license issues by; 'the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
9D
Engineering Dept. Date
Permit Fee Paid $ A -5',00 Check Number la I SIB
I
Connection Charge Receipt No. )"" Dated
Issued by
- INSPECTION
Date work started Date completed �0-29--�_3
Sufficient notificaf ion at es No
Special Conditions
AP P 0
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST 3�
DATE OF REQUEST: �D A[� �� � TIME:
BY; Ap4?&7e ag3 FOR LOCATION: LoT 71 T /
DAY INSPEC. NEEDED la/?/d TIME: t X "W
oy
TYPE OF INSPECTION: S♦ •��
( ) SANITARY/LATERAL (PERMIT .NO. ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( } OTHER
INSPECTION REPORT
DATE: - Z. - TIME: INSP:
CONTRACTOR: WEATHER: - so
WORK IN PROGRESS:
010,
LooF
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: