HomeMy WebLinkAboutDrain Layers Permit 167 Beelzebub Road N2 6334
TOWNS OF SOUTH VaMSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to written li tion,'per , sio �s y granted to the Licens d Drain Layer named herein to
perform work at T Lot#�as indicated below, at
premises owned by whose address is and
to Lay House Drain , Rep House Drain , Lay Main , Other , for
occupancy or use, with acres.
Type of'Sewage to be connected under this permit. SANITARY SEWAGE INDUSTRIAL WASTES 0,
OR:() Conneotion will be made with 3' All
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the con itions
indicated on the back of this permit..
�j
Proposed start date 5
Est, ated time for comp/erion
Pe/ �, to be issued to' r the holder of Drain'Layer's Ucense No.
Only holders of P1, P7 & W9 licenses will be Issued permit. Permit will expire thirty (301
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 TO Street Excevadon Permit No.
and/or ConnDOT Permit No. _
- Signed
Y6 Licensed Drain Layer
FOR TOWN USE ONLY
f Permit Fee Paid$ ?-,-4 (Check No.) 2.G/
Y N Connection Charge $ (Receipt No.) 6Z '7h- Dated 9-13-97'
Insurance on File (✓r( I
Bond on File (4 ( ) This permit is hey sued to the above named Drain Layer who has a valid
license issued by the State of 0oruw9but and has on Tile,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( I (✓f
Record of Sewer
Assessment OM (✓J ( 1 Issued by 1 i ) Date
INSPECTION
Date Work Started , Date Completed 4.
Comments '�'�`
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF PXQUESTt —/�� njlj� TIME: �7
.:`.. _BY: FOR LOCATION:
s _a `DAY INSPEC. NEEDED C -TIME:
TYPE OF INSPECTION:
SANITARY/LATERAL-.. PERMIT"NO`- FOOTING DRAIN:!
EXCAVATION (PERMIT NO. ) ( ) OTHER
4
INSPECTION. REPORT
- DATE.: 9 st TIME: t: 'sINSP:
CONTRACTOR: WEATHER'':. t - ::t
WORM .IN. PROGRESS: . :5 n2,36
Q " �-�L'1z-'" �'�•CUC.€-°f°'� •9) -f� � cam. �,l s
1^ `z— 00 F -70
6
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AREA OF CONCERN: G P �-
1 t % ,
`SPECIAL INSTRUCTIONS:
-