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HomeMy WebLinkAboutDrain Layers Permit 95 Carson Way r, 6405 TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT DATE:_,) Pursuant to written application, permission is ereby granted to the Licensed Drain Layer named herein to perform work at Or' Lot# - as indicated b low, at premises owned by 3 M 64/754 whose address is !;-& and to Lay House Drain Repair House Drain , Lay Main Other for occupancy or use, with LWI acres. Type of Sewage to be connected under this permit.• SANITARY SEWAGE. INDUSTRIAL WASTES(J, OR(1' Connection,will be,made With 35' Al/ work to be in accordance with Town of South Windsor standards, al/OSHA requirements and the condidons indicated on.the back of this permit Proposed start date 9" �,Est/m ed time for comp/edon Permit is'to be issued toy/' the holder of Drain Layer'sY License No. : .Only holders of P f, P7 & W9 ` censes will be issued permit. Per will expire th/rty (30) days after date of issuance, The undersigned.Drain Layer hereby agrees to al/the terms and conditions set forth in the permit and the reverse side thereof. Applicant has received Town Street Excavation Permit No. and/or ConnDOT Permit No. Signed Layer 17 FOR TOWN USE ONLY Permit Fee Paid $ 0 O (Check No.) Y N Connection Charge $ 6 oo'•o© (Receipt No.) 1-1611 Dated 3/2-6/9 6 Insurance on File (V( 1 Bond on File f N( I This permit is hereby issued to the above named Drain Layer who has a valid license issued by the State of Connecticut and has on Re,satisfactory bond Prem/ses subject to and insurance in the name of the Town of South`Windsor. Intertown Agreement (_J(fit Record of Sewer Assessment ( J( J Issued by /r ' Date �—Z_Y_ INSPECTION Date Work Started -5r zia 'C Date Completed .5e Zz z/94 Comments APPROVED -, �Insfor Date SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST:. : TIME: BY: pock �c i FOR LOCATION: DAY IN5PEC. ,NEEDED �� TIME: TYPE OF INSPECTION: ( sANITAxY LATER (P I2 . �' }. E }. , EOOT.II�IC:-.'DRAlN. - ( ) EXCAVATLON (PERMIT -NO. ) ( J OTHER IMSPECTIOtC.REPO T, DATE: TIME:- >_ ys-2 INSP: F ` CONTRACTOR ` WEATHER WORK IN PROGRESS /�.00 ► �GKG'/�Y.��—B`1� � !'�G G�.15 lei p xr- eoif^e row i!�Sihi7R�C+� Es.�/G'/2 ,��T, t'trd..tff� I.�i4 1`E Ir✓S i'/3d t fir.¢j i:�? Jb'/fir f i'Ys=z ..r r•ae rB-� E ter°sr vv rio.J G.rv.� .y a ds d'" 2°a.;3d e�.�tr T® ,FFiC�' s- c�B`csr � .��'"eD$ �irr�t► o.� .'s.v.•✓ ,>�_�D �f�rv--��-4's9 i-i�cN s»v.��-'..�e�' Tds t.�,�✓ .arm AREA OF CONCERN: SPECIAL INSTRUCTIONS: