HomeMy WebLinkAboutDrain Layers Permit 38 Alison Drive CA
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: f11
9
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to
perform work at `31- 4 k/S s A/ Lot# as indicated below, at
premises owned by AX uck 16 F*R whose address is 3$ dt-IS CA/ and
to Lay House Drain , Repair House Drain , Lay Main Other , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGEX INDUSTRIAL WASTES l J,
OR(J Connection will be made with ``f V Ca Aff
work to be in accordance with Town of South Windsor standards,all OSHA requirements and the conditions
indicated on the back of this permit.
E
Proposed start date Z o 9 C Estimated time for corm_Rledon S 2
Permit is to.be issued to 7(Ji'� Gi �,�£' the holder of Drain Layer's License No.
00 20 77Z-J . Only holders of P1, & W9 licenses will be issued permit. Permit will expire thirty jf;n
days after date of issuance. The undersigned Drain Layer hereby agrees to a terms nd con ' 'ons set
forth in the permit and the reverse side thereof, Applicant has received To eet vatio it No.
and/or ConnDOT Permit No.
Signed
libce ed Drain Layer.
FOR TOWN USE OK Y
Permit Fee Paid$ ems. oo (Check No.) 1/ ,S`<s57- 0
Y N Connection Charge $ e-o O (Receipt No.) g y3z Dated r r
Insurance on File
Bond on File 6Gl ( 1 This pennit is hereby issued to the above named Dnaln Layer who has a valid
license issued by the State of Connecticut and has on Tile,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( J ( I
Record of Sewer Ile
Assessment ( J ( J Issued bye ,/�r Date f:
INSPECTION' f
Date Work Started /zo 6 Date Completed 11z�
Comments
APPROVED:
'Inspec Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: �`�y `1 TIME:
: BY: v-'//�'�.bs: �s �riC FOR LOCATION:
'DAY .INSPEC. NEEDED TIME:
TIME: ��GL
TYPE/OF INSPECTION:
;. d SANITARY/'FATERAT,";` Pl I , ,' NG... �S� Z
( } (-- � � (-: }.. FQQTINGa:DRALN,: -.. .
( ) EXCAVATION (PERMIT'"NO ) ( ) OTHER-.
f
[NSPEGTlO 44,RE�ORTi..:
DATE:: � c G -TIME: INSP:
WEATHER-k
WORK -IN PROGREESs
OF
/r A c
AREA OF CONCERN:
u` SPECIAL INSTRUCTIONS: -