HomeMy WebLinkAboutDrain Layers Permit 544 Buckland Road (3) A 6412
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to written application, permisslog i hereby granted to the Licensed Drain Layer named hereinto
perform work at e Lot# as indicated be/o at
premises owned by ' Crf'whose address is 31? -dos ram' and
to Lay House Drain , Repair House Drain , Lay Main , Other k1 for 65/y 9�9 7
occupancy or use, with acres.
imp
Type of Sewage to be connected under ois permit•. SANITARY SEWAGE. 0, INDUSTRIAL WASTES(1,
OR (1 Connection will be made with A#
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
indicated.on the back of thi�s/parrit.
Proposed start date T `� Estimated time for completion
Per it 's to be issued to 7' d e holder of Drain Layer's License No.
Only holders of l P7 W9 licenses will be issued permit. Permit well exaire thirty (301
days after date of issuance. The un ersigned Drain Layer hereby agrees to all the terms and conditions set
forth in the permit and the reverse side thereof, Applicant eive n S ExcavA4aq Permit No.
andfor ConnDOT Permit No.
Signed
censed Drain Layer
FOR TOWN USE Oft Y
Permit Fee Paid$ (Check No.)
Y Y Connection Charge $ (Receipt No.) - -- Dated
Insurance on File ( 1
Bond on File (V1, This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connec cut and has on file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( ) A41
Record of Sewer q /
Assessment O ( 1 Issued by Dateg i b
1
TV ^1v <6
INSPECTION
1 Vt 0vj tiro
Date Work Started Date Completed
Comments
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: y 6 TIME:
BY:— FOR LOCATION: a3" `� �'r.�C;c`G�.✓,d� d
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
r�s�e'o..✓,✓e''�Y
( J/) SANITARY/LATERAL (PERMIT NO. , --11Z ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
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s�z/� rs.rgw�pr.�a ..s.se-.vr,ttr ✓v`® r�vc4d,•?
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.Y"[��S' r��s~ O✓Gr' N/L G G.✓S E �"O��. �"� .Pa�-y"...3`�r�d'O.t<G�`-. �e'l �i�Ja
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y � a fi•rvs �s z fir/- ___ ss`�Ea'.e's.."J,.,- _.-�'.-,.-f-:._,> ,�"r . =:.. m'r''.�•.�a�/,F-rr' �/.<o�`a'
67
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: