HomeMy WebLinkAboutDrain Layers Permit 643 Burnham Street Nn 6319
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
�CH?tP�Z. DATE:
C ¢Pursuant to written lication, ermsson is herek ranted to the ce sed Drain La er named herein to
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perform work at fy¢3 W,6U1' Rw f**A _Mom' r��s indicated below,at
premises owned b whose address is G if Gt// ibl ESf and
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to Lay House Drain ` 1/, Reg it ouse Drain , Lay MainAL., Other , for
occupancy or use, with acres. W/w YL r e Arwr4e6--p-r for
Type of Sewo2 to be c nected under this permit.• SAN/TARP SEWAGE 0, INDUSTRIAL WASTES(1,:
OR f J a 6ti/c� Connection will be.made with All
work to be,/n accorda ce with Town of South Windsor standards, al/OSHA requirements and the conditions
/ndicated on the back of this permit.
Proposed start date - Estimated time for completion J
Permit is to be issued to the ho�ldeT tiff k La a a6G se No.
. . Only holders of Pl, P7 W9 licenses wil be issued permit. Permit will exvire thirty t3b1
days after date of issuance. The undersigned Drain,Layer hereby agrees to all the terms and conditions se't
forth in the permit and the reverse side thereof. Applicant has r ceived own Street Excavation Per�rittf No.
and/or ConnDOT Permit No, „
Signed
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Gcens Qra' Layer
.. FOR TOWN USE OK Y
Permit Fee Paid$ _(check No.) 4( -7-
Y N Connection Charge $ g:&w,v o (Receipt No.) 6, Datod
Insurance on File k1f( 1
Bond on File (w/( 1 This permit is hereby issued to the above named Drain Layer who has a;Yhd
license issued by the State of Conneadho and has on file, satisfactory: fr,
Premises subject to and insurance in the name of the Town of South Windsor '
Intertown Agreement M ( 1 ti
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Record of Sewer
Assessment ( 1O Issued by Qate� -
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INSPECTION
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Date Work Started ;i Date Com le�ed
Comment
APPRGO q-
ED' `
Inspectors x ' Date
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SANITARY LATERAL & .EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: ( S TIME:
BY: FOR LOCATION: LG
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
(.: sAKNITARY/'LPTERAL-' (PERMrZr `Nf}�:: (p� )° (., y.:
FOOTINn DRAT .
( ) EXCAVATION (PERMIT NO y ( ) OTHER
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INSPR ECT-10 =RE 0FtT: .;--
]DATE: Z �1 TIME: ji 3d -INSP:
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CONTRACTORt WEATHER
WORK IN PROGRESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
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