HomeMy WebLinkAboutDrain Layers Permit 10 Wedgewood Drive I
1Psz2� TOWN OF SOUTH WINDSOR
Q o.
Qc t tr`� DEPARTMENT OF PUBLIC WORKS
�1 BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
19
Pursuant to written application, permission is hereby granted to the
Lice n ed Dra n Layer amg�d/ herein to perform the work indicated below at
C /U at premises owned by -J 3-M CUfI S-r/v
whose address is / G' and to
Lay Hose Dsa n, Repair Hou a Drain, Lay Main, Other 1 ;'
for occupancy or use, with��w�,�s,�� �
Family Units, ith acres .
Type of .Sewage to be connected under this permit : SANITARY SEWAGE ( ) ,
INDUSTRIAL WASTES ( ) , OR ( )
Connection. will be made with
Show sketch of proposed 'work or furnish two (2) copies If separate drawings.
OS A REQUIREMENTS MUST BE FOL PWED
SPECIAL CONDITIONS �G e o
Desired Starting Date Estimated Time for Completion
Permit to be issued to
the holder of Drain Layer ' s License No . 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 4
icens rai Layer
The above named Drain Layer has a valid license ssue by the State of
Connecticut 'and . has filed a satisfactory bond and insuran a policy in the
name of the Town of South Windsor:
Engineering Dept . Date
Permit Fe-e Paid Check Number Cq
Connection Charge Receipt No. .L/5/E, Dated /0?-/5-?y
Issued by f�
INSPECTION
Date work started -x-7 0 9"' Date completed 3 r 2 qn 95
Sufficient notificatl-un rece ve es No --
Special Conditions r
A P P R ONXIg-ee2br 3257
nspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE 0 '�REQUEST: 3 ZQ- 9S TIME: l; �(�
�
BY: FOR LOCATION:
DAY INSPEC. NEEDED ?j "Z8/lam TIME:
TYPE OF INSPECTION:
( `SANITARY/LATERAL (PERMIT NO. ' <FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE:' j Z g—,�$ TIME: / ' 3 d INSP:
CONTRACTOR: �'j�.� ' WEATHER:
WORK IN PROGRESS: s Give G'
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: -