HomeMy WebLinkAboutDrain Layers Permit 0430 Avery Street �F'rP'Si .1tv.
639'
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAN YER'SP
DATE: C26
Pursuant`to written ap /cat/on,flermimioh.4 nerebygranfed to the Licensed Drain Layer named herein to
perform work at ! Lot# indicate below, at
premises owned.by t whose address is J ' a
to Lay House Drain J%6 r H use Drain., , Lay Main , .Other for
occupancy.or use, with acres.
Type of Sewage to be connected under.this permit.. SANITARY SEW40 A1, INDUSTR1 L WASTES 0,
OR O Conneodon will be.made with l' � Al/
work to be iri accordance with Town'of South Windsor standards, al/OSHA requirements andthe conditions
i indicated on.the back of this permit
y
Proposed start date _. imared,tiiaa for comp/edon
Permit is robe issued to, S ''r06A, e i��� r > C ayer's License No.
Only hvJderS of P 1, P7 & W9 licenses wi//b issued permit. Permit will Wgb thirty (30)
days after date Of.issUOce: The undersigned Drain Layer hereby agrees to al/the;wires and conditions set
forth in the permit and the reverse side thereof. Applicant has ceived Town treat Eaccavatyon Permit Na.
end/or ConnDOT Permit No.
Signed -
/co! '� a Licens Drain.Layer
FOR TOWN USE ONLY
Permit Fee Paid S �•C)D (Check No.X-�!7PT `tb00
Y N Connection Charge S ,0J) (fit) (Receipt No.) Dated
Insurance on File fVf f 1
Bond on Fi/e ((A ( I This permit is hereby issued tv the above named Drain layer who has a valid
r erase imuedd by the State of Conneadbut and has on file,satisfactory bond
Premises subject to and insurance in the-name of the Town of South Windsor. .
Intertown Agreement l I
Record of Sewer
Assessment ( I ( I Issued by Date Zf
INSPECTION
nd
Date Work Started Z-" Date Completed 2� Z7'g�
:Comments
APPROVED:
Z?�g
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: hz,l TIME:
BY: FOR LOCATION:T__
DAY INSPEC. NEEDED 1i��(� J TIME: P �
TYPE OF INSPECTION: 1
( SANITARY/LATERAL (PERMIT NO. 63 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
- DATE: 2-' ZCo 27 — 5�6 TIME: INSP:
CONTRACTOR: ✓1;lm4,5 T/f/�uy L' WEATHER:
WORK IN PROGRESS :_
r:
AREA OF CONCERN: .
SPECIAL INSTRUCTIONS: