HomeMy WebLinkAboutDrain Layers Permit 224 Carriage Drive 6354
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: / r Q
Pursuant to written application, permission fsreby granted to the licensed Drain Layer na ed herein to
perform work at act r'-r i gr— 2 > Lot#_Y_as indicated below, at
premises owned by o A.J whose address is �a and,
to Lay House Drain , Rep fr House Dram,----_, Lay Main , Other , for
occupancy or use, with acres.
Type of Sew ge,to k5 connected under this permit: SANI;4RfY SEWAGE1), INDUMIAL.,.W�.$rES(1,
OR,O I Connection wi/1 be made with � ' %`"!/C Al/
work to be in accordance with T wn of South Windsor standards, all OSHA rv,yV,ements and the conditions
indicated on the back of fnfs'peit:' ""
Proposed start date /Off`' 7`d 'Astiipd time for comp/etfon
Permit is to-be issued i+ the ha(der of Drain Layer's License No. ,
Only holders.„of P1; P7 & Rl censes;wg!b¢ s 4gAl er►ait.
days after date of/ssuaKcg"` The ur dersigfied L iafn Layer hereby agrees to aff the terms and con loons set
forth in the permit and,#he reverse side thereof. -App/icant.has� recptvsal w et Evoav on Pe"it No
and/or ConnDOT Permit l o. ` ""
Sfgne¢,
Ucense Drain er
FOR.r0WN USE ONLY ,.
•, Permit Fea Paid s!.. r r.(C k Nab-. . .R
N Connection Charge $ -PbSjffleceipt No.) Dated
Insursnpg.on File
Bond on File 0 f ) This permit is hereby mued to the above named Drain Layer who has a valid
Ilcense issued by the State of Connecticut and has on Erie,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( 1{
Record of Sewer
Assessment ( ) t ssued b Date �� J
3 3F A&
INSPECTION
Date Work Started Date Completed
Comments
APP VED•
Inspector •� Date
5 �,it-
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OE:"KEQUEST s I(J- "TIME::— Cc :C)
-----------
BY: FOR LOCATION: oarrt0. 1�
DAY INSPEC. NEEDED } UC. TIME:
TYPE OF INSPECTION:
( }: 8A-NITARYtLATERAI; (PERM-=I „NG-. -�;F J:Y ) ( } FOOT-ING=.DRAI-N
( } EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
TIME: INSP:
CONTRACTOR::; C�Jy% Corti r' ' WEATHER-.—
WORK �� ✓'r�s
WORK IN PROGRESS:
r
"J
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AREA OF CONCERN:
- � "r i i �����> /.i, f �,%i'-j 4�� L/U''�.� G- - j%�-J L///�G.:r:7j� /..1� l ��'��I•%�%
SPECIAL INSTRUCTIONS: