HomeMy WebLinkAboutDrain Layers Permit 25 Brook Street (2) TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 0 3895
Pursuant to written application, permission is he b granted_ to t e Lice; ed Drain Layer
named herein to perform the w rk i icated below at
at premises owned: by �� A�jq� whose^address is
and -to
Lay House Drain, Repair`House Arai"" Lay Main,' 'Other ,
for occupancy. or use, with
Family Units, with acres.'
Type of Sewage to be connected under this permit: SANITARY SEWAGE ( -USTRIAL
WASTES ( ), OR ( ) Connection will be .made-with
Show sketch of proposed work or furnish two (2) copies of.separate drawings:
SPECIAL CONDITIONS
Desired Starting Date. Estimated Time for, Comp.letion-
Permit- to be issued to �e ('IJ.�.� .y-
the holder of Drain Layer's -License No. Permit will expire thirty (30) _days
after date of issuance. The undersigned Drain Layer hereby agreeij.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 Perm t. NQ. i
Signed ' .
'Licensed Drain aver.
The above named Drain Layer has a :valld: license issu by.,the State of Connecticut and
has filed a satisfactory bond and .insurance policy, in ame f the To of.'South Windsor:
Engineering-Department:: -Date
Connection Charge Paid Perm`it Iee: Paid
Check Number d
Issued by'
�- Tax affice
INSPECTION
Date work started Date completed
Sufficient notification received: Yes No
Special Conditions /
APPROVED:
Inspector Date
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Location of proposed work:_ ed0A' Lot #
Street No. Street Name
Premises owned by:
Name of Firm: � �f '��� Phone:
Address of Firm:
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Proposed Start Date Estimated time for completion
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to the holder of Drain
Layer's License No. Only holders of P1, P7 & W9 licenses will
be issued a permit. 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 attached thereto. Applicant has received Town Street Excavation
Permit No. and/or ConnDOT Permit No.
Signed: /� Print Name:
Ucens -Aram Layer
Date:
Standard Forms\Perrnb\APPUCATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: r�
BUILDING ADDRESS
STREET
SUBDIVISION:
NORTH ARROW
i J� --
(
CONTRACTOR (PRINT) NA ONTRACTOR'S�U!PEPRINT)
STREET ADDRESS T E
Lr j t I i� DATE
TOWN STATE ZIP INSPECTED 'BY OWN
S' e DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER