HomeMy WebLinkAboutDrain Layers Permit 68 Berle Road 2 6453
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: 3 --
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to
perform work at^6'8 a"Ie-er" , Lot# es indicated be%w,'at
premises owned by whose address is 68 ae'-e e,e and
to Lay House.Drain �� Repair House Drain Lay Main Other , for
occupancy or use, with r acres.
Type of Sewage to be connected under this permit.- SANITARY SEWAGE 01, INDUSTRIAL WASTES(1,
OR {1 Connection Will be made with . All
work to be/n accordance with Town of South Windsor standards, a//OSHA requirements and the conditions
indicated on the back of this permit.
Proposed start date 4:Zre- Estimated time for comp/edon G
Permit is'to be issued to ir .✓�' �.r.ePi�✓o o�'�''Oe holder of Drain Layer's License No.
Only holders of P1, P7 & W9 licenses will be issued permit.. Permit will exaire th/rty (3O)
days after date of issuance. The.undersigned Drain Layer hereby agrees to al1 the terms and conditions set
forth in the permit and the reverse side thereof. Applicant has ved T n eet FX1087,n Permit No.
and/or ConnDOT Permit No.
Signed
FOR TOWN USE Oft Y
Permit Fee Paid S z a'. oo (Check Nod- -Y 8.�
Y N Connection Charge $ pia oo (Rece/pt No.) -,✓63 7 Dated v' z
Insurance on File w ) ( 1
h
Bond on File Iel ( 1( I This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement { I ( I
r✓O
Record of Sewer
Assessment ( I ( I issued by '� � ...w�- Date
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INSPECTION 9d �
Date Work Started Date Completed
Comments �.cse" s .v�.t .,�..► :o,��k�'.ss.ct� d�c,✓.e,!✓.rrscc�v rsl.�o�c��.�o► .�.s>.er.-�
IV O e✓ 0 �'o1�✓r✓tsCYBm 7�"X ✓y✓fim4' 'Odt r�►�YlPr►✓
APPROVED:
Inspec r Date-*.