HomeMy WebLinkAboutDrain Layers Permit 12 Virginia Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5518
//- /3 , 195
Pursuant to written applicaattihn, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at Or-Ford Lol -*,S
at premises owned by e �o�sf- whose address is
HanA e s-Fe,� o ��vr_ and to
Lay House Drain, Repair Hous Drain, Lay Main, Other ,
for c VKIt occupancy or use, with
Family Units, with a res.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (L), INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
Show sketch of proposed work or furnish two (2) copies of separate drawings.
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SPECIAL CONDITIONS
Desired Starting Date r4 Estimated Time for Completion
Permit to be issued to A L , eec
the holder of Drain Layer's License No. ,;Z084jj, PXby
it will expire thirty (30) days
after date of issuance. The undersigned Drain Layer h agrees to all the terms and
conditions set forth in the permit and the reverse side hereof. Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
used Drain Layer
The above named Drain Layer has a valid license i ed by the State of Connecticut and
has filed a satisfactory bond and insurance policy in a name of the Town of South Windsor:
Engineering Department Date
Connection Charge Paid f� v Permit Fee: Paid $ 2 �
Check Number 3
Issued by
Tax Office
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions
APPROVED:
Inspector Date
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 4/- _9 7 - �a
BUILDING ADDRESS OR LOT N2 ;,40� ci`
STREET: ZA
SUBDIVISION:
AM STATION : +
NORTH ARROW INVERT ELEV:
TIE TIE
-FT F T.
HOUSE LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
_JQ FT. FT,
BUILDING INV. EV. INV.ELEV. INV. ELEV. INV. ELEV. BUILDING
(IF EXIST.) U.
(IF EXIST.)
TIE TIE
AM STATION : +
INVERT ELEV:
Z:_6 L.4 AA A_rya ait ` 0 C
CONTRACTOR (PRINT) AME OF ONTRACTOR'S S VISOR(PRINT)
Cn k w.P v-
STREET ADDRESS TORE DATE
ZE5LLf Kl
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER