HomeMy WebLinkAboutDrain Layers Permit 11 Virginia Circle TOWN OF SOUTH WI N DSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT N2 5519
i'�c- //-13 , 1990
e � I cv
Pursuant to written applicaE ion, permission is hereby granted to the Licensed Drain Layer
named herein to perform the work indicated below at Q n Pvvd Lo-f 44
at premises owned by IIke to nfrt - whose address is
Ma-c e-JC, C - and to
Lay House Drain, Repair House Drain, Lay Main, Other ,
for I S lvl +n Ctn.,I occupancy or use, with
Family Units, with i acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE (y< INDUSTRIAL
WASTES ( ), OR ( ) Connection will be made with
t, " P VCR
Show sketch of proposed work or furnish two (2) copies of separate drawings.
t
SPECIAL CONDITIONS Ui,i4t L ot
Desired Starting Date AS A P Estimated Time for Completion I
Permit to be issued to A bMbe&^ *^ IVic_
the holder of Drain Layer's License No. ,208 4ti, Pe it will expire thirty (30) days
after date of issuance. The undersigned Drain Layer h eby agrees to all the terms and
conditions set forth in the permit and the reverse side ther Applicant has received
Town Permit No. and/or CHD Permit No.
Signed
License ain Layer
The above named Drain Layer has a valid license issued b the Stat of Connecticut and
has filed a satisfactory bond and insurance policy in the n e of the Town of South Windsor:
Engineering Department Date
�
Connection Charge Paid 3q�� �(fZ� Permit Fee: Paid $ '�� - —
Check Number g
r--
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: 1/- /!z -
BUILDING ADDRESS OR LOT N°: ozd?14-- __1116- /
STREET: X2,al f;ca
SUBDIVISION:
W STATION : +
NORTH ARROW INVERT ELEV:
TIE TIE
A-1 FT FT.
HOUSE LATERAL LATERAL HOUSE
CONNECTION STUB STUB CONNECTION
S /
FT. FT.
BUILDING INV EV. INV.ELEV. INVU. . ELEV. INV. ELEV. BUILDING
(IF EXIST.)
(I F EXIST.)
TIE TIE
AM STATION : +
INVERT ELEV:
r
C NTRACTOR (PRINT NA F C NTRACTOR' SU ERVISOR(PRINT)
.00
STREET ADDRESS S GNAT RE DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ENGINEER/DEVELOPER