HomeMy WebLinkAboutDrain Layers Permit 25 Bidwell Road (2) ;. ....., a S° P,
6362
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: /
Pursuant to written applic )io , perssigg i�hereby granted to the Licensed Drain Layer named herein to
perform work at 1�`p1, Lot# as in ated below, at
premises owned by t whose address is ,n� and
to Lay House Drain , R pair Ho se Drain , Lay Main Other , for
occupancy or use, with acres.'
Type of Sewage to be connected under this permit.• SANITARY SEWAGEOI, INDUSTRIAL WASTES(J,
OR f 1 Connection will be made with MAll
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
indicated on the back of this permit.
Proposed start date O 741,r, &a. ated"time for completion
P mit ' fo be Issued to G r i- ►-( Q f the holder of Drain Layer's License No.
c Only holders of 1� W9 licenses will be issued permit. Permit will exo/re thirty (30)
f 4Wnce. The undersigned Drain Layer hereby agrees to all the terms and conditions set
forth in w permit and the reverse side thereof. Applicant has re ivied Town Str t Excavation Penh No.
and/or ConnDOT Permit Na
Signed
Licensed rain Layer
FOR TOWN USE ONLY
Permit Fee Paid$ .OO _tCheck No.J7019C 7 R (2/E!Z 95
Y/ N Connection,Charge $ (Receipt No.) Dated —
Insurance on File (v ( J
Bond on File A J This permit is hereby issued to the above named Drain Layer who has a valid
Ikense issued by the State of Connew*ut and has on file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement ( l t I
Record of Sewer �Z/Z
Assessment ( l t l Issued by Date
INSPECTION
Date Work Started l Z 9' Date Completed
Comments
APPROVED: p
Inspector Date
INSPECTION REQUEST" T
DATE. or--.zQEST:
BY: //1 �%S �f7"Z-�,���J � FOR LOCATION:
DAY INSPEC.' NEEDED: ` / TIME
TYPE:' OF •INSPECTION:.:_
(
SANITARY LATE aAL j .. (PE1tMZT".NQ ..v4 -FOOTING DRAM . .
( j EXCAVATION- (PERMIT -NO. _
Y
OTHER
a
INSPECTION,, REPO#tT
TIME:
DATE.z
E INSP:
CONTRACTOR WKATS£A t _
WORK IN` PROGRESS: i��r/�1
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AREA OF CONCERN:
€ SPECIAL INSTRUCTIONS:
E: