HomeMy WebLinkAboutDrain Layers Permit 0393 Avery Street _.�, y,•.s+r• -i4lm-• s...�li'Cd"•�R.'�'H'�' ,�•''P'i�Y'''"i.` n'i'9tZit'.'aRin'y`.,,1Rs7�+�ise"'_7'!.� 'fir, :i`;r �sz': ;�r:��q rc ,h 'sF .."�`:`s:.T'-`_';4n.:•:;", '� -'
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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to
perform work at ��" , Lot# as indicated below,at
premises owned by 1 e JA46 'ZM k"/Y&'4 v whose address is and
to Lay House Drain , Repair House Drain , Lay Main , Other for� iYi /lyT�a L
occupancy Orr use,: with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE GJ'INDUSTR/AL WASTES(J,
OR f I Connection will be made with All
work to be in accordance with Town of South Windsor standards, al/OSHA requirements and the conditions
indicated on.the back of this permit.
Proposed start date�5�`�` �' Estimated time for completion
Permit is to be issued to ,G 13i1I ko co, the holder.of Drain Layer's License No.
ov /33 Only holders of P1, P7 & W9 ticenses will be issued permit. Permit will expire thirty (3 )
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 Street Excavation Permit No.
and/or ConnDOT Permit No.
Signed
Licensed Drain Layer
FOR TOWN USE ON
L Y
Permit Fee Paid$ cs•vv (Check No.)
Y N Connection Charge S ,00.0(.) (Receipt No.) 61 Dated
Insurance on File (�J( J .
Bond on File (ul ( 1 This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on file,sat/sfacwy bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement ( J ( J
Record of Sewer
Assessment ( I ( J Issued by -* Date -4- V'e
INSPECTION
Date Work Started Date Completed /per
Comments
APPROVED: /�
Inspe or Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: ���� TIME:
BY: FOR LOCATION:--?,?3 �
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( r/) SANITARY/LATERAL (PERMIT NO. ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME:TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: