HomeMy WebLinkAboutdrain layer permit 1224 Sullivan Avenue s
• TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT No 6021
. 19a
Pursuant to written application, permission is hereby granted to the
Licensed Drain Layer//]]�n,amed herein to perform the work indicated be ow at
j✓o� named
a pre ises owped by S
whose address is � {�� � and tq
Lay Hou Dr i , Repair House Drain, Lay Main, Other
for � occupancy or use, with f
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 prop�sed work or furnish 'two (2) opies of separate drawings.
c 6yo ���()p tiJ
117
4,311000o
SPECIAL CONDITIONS
OSHA REQUIREMENTS MUST BE FOLLOWED
Desired Starting Date Estimated Time for Completion U
Permit to be issued to
the holder of Drain Layer's License No. pc' Permit will expire thirty
(30) days after date of issuance. The unde signed 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
Licensed Drain Layer
The above named Drain Layer has a valid 6-1icense issued by the State of
Connecticut and has filed a satisfactory bond and insurance policy in the
name of the Town of South Windsor:
�? a
ngineering Dept. Date
Permit Fee Paid $ Check Number 4
Connection Charge Receipt No. , 6e0 3 67 -Dated— �j 2
Issued by
INSPECTION �®
ate work started - 3 D /� Date completed • 7 2 �
ufficient notification receive . Yes No �'—
ecial Conditions
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: �/�"' 2�"r �3 TIME: 3 9-30
BY: FOR LOCATION: 1 Z,2CJ-
- z
DAY INSPEC. NEEDED 9 - 30 : 3 TIME: �Od
TYPE OF INSPECTION:
( �ANITARY/LATERAL (PERMIT NO. t'e O ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: - 3C') 3 TIME: 9�00 INSP:
CONTRACTOR: WEATHER: 6 0 g
WORK IN PROGRESS: ca-p a:2=nz djLqrl- n4
I_ 9 r
AREA OF CONCERN:
ECIAL INSTRUCTIONS: