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HomeMy WebLinkAboutDrain Layers Permit 54 Charing Road -TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT 6281 19 Pursuant to written application, permission is hereby granted to the L c7nsad D ainn Layer na ed her in to perform the work ind cat d' belo at o 5thuh, a t r e s:e s owned by whose add ess '-is a►C and to Lay House Drain, Repair House Drain, Lay Main, Other f°r occupancy or use, with. Family Units, with acres , Type of Sewage to be connected under this permit s,I SCAN T RYSEWAGE ( , INDUSTRIAL WASTES ( ) , OR ( ) Connection will be made with Show sketch of proposed work or furnish two (2) copies of separate drawings . OSHA REQUIREMENTS MUST BE FOLLOWED SPECIAL CONDITIONS Desired Starting Date 5; Estimated Time f r Completion Permit to be issued to the holder .of Drain Layer 's License No . ? ?p $:L,-Permit will expire thirty (30) days after date of issuance. The undersig c $rain Layer hereby agrees to all tb, e. terms and conditions set forth i permit and the reverse side thereof . Applicant has received To Per No . a %or CHD Permit No . Signed Licensed Drain Layer The above named Drain Layer has a valid license issued by .the State of Connecticut and has filed: a satisfactory bond and insurance policy - in the name of the Town of South Windsor: AM Engineering Dept. Date :. Permit Fee Paid $ _� Check Number ' Connection Charge Receipt No. 57 Dated "//2 q� Issued by INSPECTION Date work started Date completed �=Z— gs" Sufficient notification recel-ved': .�_L..e---yes No Special Conditions APPROVED• Y napector Date SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE.OF REQUEST:' � TIME. v G ,•;;.:" ;-BY: PC,� C��� FOR LOCATION: C CS O i DAY.-INSPEC. NEEDED CIE TIME: 11:00 Arn TYPE OF INSPECTION: ( " }` SAKITARV LATERAIe,",."(FERKITr Not. ( }. EXCAVATION (PERMIT NO. } ( .' ) OTI:m F INSPEC-INIO REPca -r: DATE: TIME: .�©?1' INSP: F CONTRACTOR = _ WEATHER:- WORK IN PR GRESS-: —, A6� z_A" AREA OF CONCERN: SPECIAL INSTRUCTIONS: