HomeMy WebLinkAboutDrain Layers Permit 224 Carriage Drive (2) .. . ,-. ,,......., r„ ;...r„ a.-.., �.r<,- ,,,•r.• f�f.F';�' -`-fc"f;:'ic..a r. 'Sy.•:z �...;; vyn.,
633.5
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT DATE:
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to
perform work'at
Z airr , r. , Lot# as indicated be/o , at
premises owned by v1 whose address is and
to Lay House Drain a.-**",_Repair House rain Lay Main , Other for
occupancy or use, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE , INDUSTR/AL WASTES(J
OR(J Connection will be made with . All
work to be in accordance with Town of South Windsor standards, al/OSHA requirements and the conditions
indicated on the back of this
,permit. v�
Proposed start date f i Estimated time for completion /
Permit is to be issued to / �✓ G'� /��`iL the holder of Drain Layer's License No.
7 Z.okysz--- Only holders of P1, P7 & W9 licenses will be issued 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 the reverse side thereof. Appl/cant has receive Town Street Excavation Pennit No.
and/or ConnDOT Permit No.
Signed
Licensed Drain Layer
FOR TOWN USE OM Y
Permit Fee Paid$ Z!6 (Check No.) )Y 8eP<)
Y N Connection Charge $ eoo~v - (Receipt No.) H y'?!a Dated
Insurance on File (X! ( 1
Bond on.File {jd 1 J This permit is hereby issued to the above named Drain Layer who has a valid
I/cense issued by the.State of Connecticut and has on file,se sfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement ( ) hit
Record of Sewer
Assessment -4 -.- Issued by Date
INSPECTION
Date Work Started Date Completed
Comments
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE:OF. REQUEST.,. TIME:
BY: FOR LOCATION:
DAY. INSPEC. NEED TIME:
TYPE-,OF' `'INSPECTION
y ( } SA1+ ITARY'/LATEIZALa'- (PIRFAIfi' Nf}. -4 3 3 5 }— ( } F:O0.TING :DRAIN- ..
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER -
E
INSP4ECTION RrEPORT- "
DATE:. h TIME: INSP: ✓� 2`�
CON=CTOFt �fi WEATH-EFL
WORK _IN PROGRESS-:
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AREA OF CONCERN:
`SPECIAL, INSTRUCTIONS: