HomeMy WebLinkAboutDrain Layers Permit 0120 Avery Street r
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6363
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT /J)
DATE:
Pursuant to,written application, permission is hereby pranted to the Licensed Drain Layer named herein to
perform work.at Lot# as indicated be%w «o,y
premises owned by S. ;w o U _ u ee i` whose address is 1 / �Ain4�� anal"
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 SEWAGE,,(), INDUSTRIAL WASTES(l,
OR{1 Connection will be made with AI/
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the.conditions
indicated on the back of this permit. ,
Proposed start date wo t/ / Estimated time for c mp/etion l
Permit is,to:be issued to ► V"491,0A the holder of Drain Layer's License No.
Only holders of'P 1;CP7,3 W9 licenses will be issued.permit. Permit w.i/l expireirt�f301
days after date pt issuance. The undersigned Drain Layer hereby agrees to al/the terms and conditions set
forth in the permit and the reverse side thereof. Applicant has re wn Str et ation Permit Na.
and/or ConnDOT Permit Na
Signed
' Licensed Drain Layer
FOR TOWN USE ONLY
Permit Fee Paid S _(Check No.) �8�
Y N Connection Charge $ 0A_ (Receipt No.) Dated
Insurance on File a( 1
Bond on File (06 J This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecdcut and has on file, satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement
Record of Sewer �/
Assessment ( l ( 1 Issued by Date / J
INSPECTION
Date Work Started /f 7 -r35 Date Completed // a7-1
Comments
APPROVED:
Inspector Date
r SANITARY;LATERAL:_&..EXCAVATION PERMIT
INSPECTION REQUEST
DATE'..-OF REQUEST: 111(�/G�( TIME: �� t
BY: FOR LOCATION: �C
r GYM
t DAY "INSPZC. NEEDED l lI7 9J TIME:
TYPE-OF -INSPECTION:
( SANITARYILATER=._:.(`PERNIfi•`N€ .- 3 )" (' ) - FOOTING DRAIN
EXCAVATION . '(P.ERKIT..NO. ) ( . ) OTHER
INSPECTION-REPORT . .,
DATE,z /��Lg ? -t5� TIME: = 3y INSP:�s3�
CONTRACTOR:` /OLD WEFrTffER'
WORK- IN PROGRESS.: L
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: