HomeMy WebLinkAboutDrain Layers Permit 52 Willow Street a•.F'M �vn. ...Fri )2.i nux sI'y.;7.:.. 'l. :A•-+y'r..�'1'.6 hiZyH'.R`MC,r+.' ei{�'�.T;- :L.. ..�R.xr{..LG�g,'�'j' + ...
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TOWN OF SOUTH. WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POTLUTION CONTROL
DRAIN LAYER'S PERMIT _. f 131'
9 19 � -
Pursuant to written application, permission is ereby granted to the
Licensed Drain Layer 'name.d herein to perform the work indicated below at
Sod W/-t1_0&j S-r- at premises owned by \16yti ,Srf,8/7-Z-
whose address is 5-. . G, 1 cow ST and to
Lay House Drain, _g_Repair House Drain, Lay Main, Other ,
fo'r occupancy, or use,, with
Family Units, with acres.
Type of Sewage to be connected under this permit : SANITARY SEWAGE ,
INDUSTRIAL WASTES ( ) , OR ( ) K
Connection will be made with
' Show sketch of proposed work or furnish wo (2) copies of separate drawings.
OSHA REQUIREME TS MUST BE FOLLOWED
SPECIAL CONDITIONS
Desired Starting Date a ,.• Estimated Time for Completion
Permit to be issued to o 1Nf1 1
the holder of Drain Layer 's License No. Zo77s1S . 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 hatreceived Town Permit No. nd/or `
CHD Permit No.
Signed
Li a sed Drain Layer _... .:
The above named Drain Layer has a valid license issued by the ill s .
Connecticut and has filed a satisfactory and and insurance policy.
name of the Town of South Windsor: All
,
E gin ng Dept. Dat
Permit Fee Paid $ a ,od Chec umber_
Connection Charge Receipt No. �1� ,9 = t ~
$ P '7 ��,�j Dated �: .
Issued by "
INSPECTION
Date work started (p�1D "Ol _,.., Date completed " � �
Sufficient notification receiv-ea: yes No
Special Conditions
APPROVED:
Insp cto Date
y .
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: cw R� Ck , lqQ� TIME: cf� ry-\
BY: d,C�c�S Seo-�tC FOR LOCATION:
DAY INSPEC. NEEDED 6IL61 (?y TIME: /-)m
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE:- s�(� P TIME: INSP:
o .
CONTRACTOR: r WEATHER: Q t
WORK IN PROGRESS: f D• C r
�� r 0 A,I
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: