HomeMy WebLinkAboutDrain Layers Permit 032 Austin Circle t
643.9
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to written a plic don, permission is is granted to the Ucense-d Drain Layer named herein to
perform work at 3 C , Lot# $,�as indicated belo
premises owned by 1 4 whose address is '
to Lay House Drain , Repair House Drain , Lay Main , Other f
occupancy or use, with. acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE. ,IINDUSTRIAt VASTES O,
OR O Connecdon will be made with Al/
work to be in accordance with Town of South Windsor standards, a//OSHA requirements and the vondidons
indicated on the back of this permit.
Proposed start date - �" � -�(� Estimated time for completion l�`b
Permit to be issued to - C-M Ai4j , the holder of Dn Layer's License No.
Only holders of P1, P7 & W9 liven es will be issued permit. Permit will expire thirty (30)
days after date of&Vance. The undersigned Drain Layer hereby agrees to a//the terms and cona/tions-set
forth in the permit and the reverse side thereof. Applicant has received Town Street Excavation Permit No.
and/or ConnDOT Permit No.
Signed -4 A
LicjoidpmOWLayer
FOR TOWN USE ONLY
Permit Fee Paid$ z ,v v (Check No.) 7t *�JV
-Y N Connection Charge S,roo, oo (Receipt No.) <*.r9 ,� Dated
Insurance on File (�f(
Bond on File 64 O This permit is hereby issued to the above named Dram Layer who has a valid
Ikense issued by the State of Connecticut and has on file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( I ( 1
Record of Sewer
Assessment ( 1O Issued by Date <' is L
ICI
INSPECTION
Date Work Started C•i>-Ar Date Completed
Comments
APPROVED:
Inspect4 Date
SANITARY LATERAL & EXCAVATION PERMIT
L INSPECTION REQUESTa
DATE OF REQUEST: �Ph ` ` 47 TIME: —Poll
BY: � ` "G FOR LOCATION:117--P3 3z T7�c. i
DAY INSPEC. NEEDED �n TIME: / �A"i
TYPE OF INSPECTION:
V SANITARY/LATERAL PERMIT 0. � FOOTING DRAIN
{ ) ( 39 ) { }
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: � TIME: INSP:
CONTRACTOR: WEATHER:
.WORK IN PROGRESS: /t�.�/6r� �iPE" v.✓�+o'�z .�®m ri.-.�C
�G G cG Dior.✓ s'�'��
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: