HomeMy WebLinkAboutDrain Layers Permit 85 Birch Road �, �, /� /Lloill tom✓
6423
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION-CONTROL
DRAIN LAYER'S PERMIT
DATE: 37/ ® C
r Pursuant to writt�3. is ion per 'ssion is here¢y_granted to the Licensed Drain Layer named herein to
perform work at O 8/ C�V.�� Lot# s indicated belo at
Premises owned by hose address is � and
to Lay House Drain !/, Ifepair House Drain , Lay Main , Other for.
occupancy or,use, with acres.
Type of Sewage to be connected.under this permit. SANITARY S W r+zEA INDUSTRIAL W TE (J,
OR(1 Connection will be made with �'' �C44wA#
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 / Est' a tY7e for completion
Permit is to be.issued to __G /G the holder of Drain Layer's License No.
66 a 0C(Pf6. 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.Town a anon Permit No.
rYW-� _ and/or ConnDOT Permit No. /l —
Signed
Licensed Drain Layer
FOR TOWN USE ONL Y
Permit Fee Paid$ A 5 : D 6 (Check No.) /V0,6 y
Y N Connection Charge $ God,oO (Receipt No.) lfa6T Dated 3' io y 6
Insurance on File (✓j( J
Bond on File (✓J( J This permit is hereby issued to the above named Drain Layer who has a valid
lkcense'issued by the State of Connecdcut and has on file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( 1 ( 1
Record of Sewer
Assessment ( J ( I Issued by Date s.0 94
INSPECTION
Date Work Started / �,c Date Completed
Comments
APPROVED:
Insp or Dat
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST:-- , TIME: .a�`�✓
BY: `_�i/ ��� FOR LOCATION:
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. 6-Y03- ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
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VIOLETTE SILVESTER SC SONS,INC.
► 65 Cherry Street
East Hartford,CT 06108
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