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HomeMy WebLinkAboutDrain Layers Permit 0431 Avery Street TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT fi 140 Pursuant to written application, permission is hereby grantedto ,the Licensed �ain I,a�er named herein to perform the work indicated below at_ at premises owned by ose address is � T—and to Lay Ho se D ain Repair House Drain, . Lay Main, Other , ford Q occupancy or use, with , Family Un ts, with _acres. Type of Sewage to be connected under this permit : SANITARY SEWAGE , INDUSTRIAL WASTES ( ) , OR ( ) Connection will be made with Show sk`eich of proposed work or furnisg 'tw-6 !( ) opies o to drawings. K U G OSHA REQOIREMENTS MUST BE FOLLOWED SPECIAL ' 60W"DITIONS!� Desired Starting Date Estimated Time for Completion Permit to be issued to C the holder of Drain Layer's License No. . . D Permit will expire thirty (30) days. after. date of issuance. The undersigned Drain Layer hereby,.agrees to all the teams and conditions set . forth in the permit and the reverse side thereof. Applicant has received Town Permit No, andlor:. C.HD Permit No . .� Signed Licensed Drain Layer The above named Drain Layer has a .vali license issued by the State of Connecticut and has filed a satisfactory bond and insurance policy an the name of the 'Town of South Windsor: Ail, j _ Engineering Dept. Date Permit Fee Paid $ fir Check Number _��.1} Connection Charge Receipt No. Dated -awl, r Issued by !INSPECTION bate work started Z3 �3 ?Sufficient notification receiv cr: `�e8te compNeoted { Special Conditions i APPROVED: Inspector . Date r - SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: (� 'Z'/ ©j�f TIME: BY: V // 72(��`i �jG�i�-�Zi' FOR LOCATION: DAY INSPEC. NEEDED TIME: ff TYPE OF INSPECTION: O SANITARY/LATERAL (PERMIT NO. /yD ) ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE: 3 9L/ TIME: INSP: 17 CONTRACTOR: �vy=� WEATHER: WORK IN PROGRESS: AREA OF CONCERN: SPECIAL INSTRUCTIONS: