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HomeMy WebLinkAboutDrain Layers Permit 400 Benedict Drive TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT 1' 6049 19 Pursuant to written application, permission is hereby granted to the Licensed ain L ysr n red herein to perform the work ind��K b l w at at pr m es owned by ff whose address is p dr - and to Lay House Drain, Repair House Drain, Lay Main, Other for occupancy or use, with Family Units, with acres. Type of Sewage to be connected under this permit : SANITARY SEWAGE INDUSTRIAL WASTES ( ) , OR ( ) Connection will be made with Show sketch of proposed wo or furnish two (2) copies of separate drawings. _SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED Desired Starting Date Vo Al Estimated Time for Completion S ri y Permit to be issued to / / . e,-'0'0 /5> . (, the holder of Drain Layer's License No. Permit will expire thirty (30) 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 Permit No. ^ and/or CHD Permit No. Signed icense Drain Layer The above named Drain Layer has a valid license issued by the State of Connecticut and has filed a satisfactor and and insurance policy in the name of the Town of South Windsor: ( E gfrvkkking Dept. Date Permit Fee Paid Che&k umber 50 Connection Charge Receipt No. Dated Issued by INSPECTION Date work started --� — Date completed Sufficient notifica on rece ve es No Special Conditions APPROVED Inspector Date SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: ,ll `` < TIME: v s BY: Zb ^ FOR LOCATION: 4eo qz 3� DAY INSPEC. NEEDED I�/��Ol / j TIME: yJ TYPE OF INSPECTION: ( V) SANITARY/LATERAL (PERMIT NO. �d } ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE: TIME: :0 O INSP: CONTRACTOR: i� � WEATHER S© ° WORK IN PROGRESS: 1,ZZ' c � AREA OF CONCERN: SPECIAL INSTRUCTIONS: