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HomeMy WebLinkAboutdrain layer permit 48 Sullivan Avenue TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS 1_Ip BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT 6239. • 2.. 1915 _ Pursuant to written application, permission s hereby granted to the Licensed Drain Layer named herein to -perform the work in t d below at �'g S •irz3-,.. Qom, Q - at premises owned by _ vr 0�� whose address is and to Lay House Drain, Repair House Drain, Lay Main, Other for /�,r.G occupancy or use, with Family Units , with 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 of separate drawings . l//�jCoNNC CAP (`X IS77AJEj �Jf�vl Z4T&� a 77-) �ovSe -130A-)0 9 r7W 0c.isy -f> SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED Desired Starting Date /- 17-95- Estimat-ed Time for Completion Permit to be, issued to the holder of Drain Layer 's License No . 2.08.23 '7 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 ice se D in Layer The above named Drain Layer has a valid license issued by the State of Connecticut and has filed a satisfactor b nd and insurance policy in the name of the Town of South Windsor : E gin ng /Dept . Date Permit Fee Paid $ Z QU Chec Number (191W Connection Charge Receipt No. AJ ,0 A) - Dated — Issued by INSPECTION \D 1(/ Date work started l �` !� Date completed �319.� Sufficient notifica on received : yes No .: 7ecial Conditions APPROVED: 1 ,3 ns ector Date SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: 2- 5- TIME: R! 3zo BY: FOR LOCATION:����(/�tt�;z,,. DAY INSPEC. NEEDED 2-5 -9!; TIME: A�� TYPE OF INSPECTION: XSANITARY/LATERAL (PERMIT NO. FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE: Z _ TIME: ,` 00 INSP: &Arz", CONTRACTOR: f WEATHER: 3 s o .4z WORK IN PROGRESS: --- 12 LIZ o < J-ee,, IkA E"":Z- all Ar7 lvo AREA OF CONCERN: - SPECIAL INSTRUCTIONS: ",, • kA: I i ate; RECEIV District 1 ,b(�Pt1; 2 7 1i99'5- Solo vi F;DSO;c .-�• TelephQn all Report �?3.0 ['T. Oj Conn- D-O-T_ Construction - Unit .601 'Project No. (32-ft�` Contractor or Consultant : RZ - T me: o ct0a Start Date 010,5'.. End Prepared by: M r K I. Call Participants: a© )A- I� w �i II. Discussion- - " r a MS 10 al W1 E-9r' v2c h1Cr lW A r r III Follow-Up Items and Conclusions: (Indica.te who will do follow-up) �t M2 v S `t-L1A Z LJ0016� i,4,5PE 1Di/, 9 G--h MIN !s ���