HomeMy WebLinkAboutDrain Layers Permit 310 Benedict Drive g65 00�
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIYI'
DATE:
Pursuant to written application, permission/s hereby granted to the Licensed Drain Layer named herein to
perform work at 3 10 (3 8 N ty p!C-r D r , Lot d 310 as indicated below, at
premises owned by 2i (QRN�NF whose address is and
to Lay House Drain 1 Repair House Drain Lay Main Other for
occupancy or use, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE. N, /NDUSTR/At SJ'ES(1,
OR f 1 Connection will be made with 6`�VI/ 1ff.. 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 Q Estimated time for completion /�'✓� ,� 5
Permit is to:be issued to Q' 461deur of Drain Layer's License No.
00-24* %S8 Only holders of P1, P7 & 9 licenses will b sued permit.. Permit will expire thirty (30)
days after date of issuance. The undersigned Drain Layer hereby agrees to al/the terms and condNons'set
forth in the permit and the reverse side thereof. 'Applicant has received.Town Street Excavation Pennit No.
and/or ConnDOT Permit No.
Signed
Licensed DrWin Layer
FOR TOWN USE Oft Y
Permit Fee Paid$ 00 (Check No.)�0 O
Y N Connection Charge $COo.O O Me No.) e(,J Ll Dated -1"I
Insurance on File M('1
Bond on File 60( ) This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the Stage of Connecticut and has on file,sedsfactory bond
Premises subject to / and insurance in the name of the Town of South Windsor.
Intertown Agreement
Record of Sewer Assessment O ( 1 Issued by Date 61n 1119 ,
INSPECTION
Date Work Started 'Chr 9< Date Completed
Comments
APPROVED:
Inspec, Date �--
SA ITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: #� ?" 1� TIME:
BY: (l? Lttiayl .� - FOR LOCATION 3IoJt�/GT l„/fZ
DAY INSPEC. NEEDED TIME: G
TYPE OF INSPECTION:
( Vr SANITARY/LATERAL {PERMIT NO.6¢ ) ( ) FOOTING DRAIN
E%CAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: - . TIME:, INSP: ,
CONTRACTOR: WEATHER
WORK IN PROGRESS: ��G
��/�Oo2 e�L.U��BIi✓C
AREA OF CONCERN: .
SPECIAL INSTRUCTIONS: