HomeMy WebLinkAboutDrain Layers Permit 153 Clark Street y. ..�. .r ^--,+ ®r'K.v - ` �•' ..,,.Ir�� `..x
- 6450
TOWN OF-SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: deA�
Pursuant'to written ap�vlication, permission is hereby granted to t/e Licensed Drain Layer named herein to
perform work at Lot# as indicated below, at
premises owned by S V,-))c x . /V a olyle c� whose address is and
ca
to Lay House Drain. 4,-, Repai Ruse Drain'-_, Lay Main Other , for
occupancy or use,. with acres.
Type of Sewage to be connected under this permit, SANITARY SEWA, 1, INDUSTRIAL VI/ASTES(J,
OR.(1 SQ 4.-hz�,� Se — y Q c on will be made with All
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
4 indicated on the back of this permit:
Proposed- date �' �6 Estimated time for comp/edon / c. Cy
Oe P ie,;o be issued to -fEl~ �/ ��`�`�c 1��e holder of Drain Layer's License Nv.
Only holders of P1, & W9 licenses will be issued permit. Permit will axnre rty M
days after date bf issuance. The undersigned Drain Layer hereby agrees to a//the terms and conditions set
forth in the permit and the reverse s/de thereof. . Applicant has.rece/v T n Str Ex vativn Permit No.
and/or ConnDOT Permit No.
G",&y,J' y ` z a Oo 3 63 _Signed
Licensed Drain Layer
FOR TOWN USE Oft Y
-hermit Fee Paid $ 6CO Q0_(Check No.)
Y N Connection'Charge $ oZ 4S'.oc> L�JReceipt No.) 46 3y Dated 6•Z5-9 6
Insurance on File
Bond on File 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 No,setisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement ( 1 ( I
Record of Sewer
Assessment { I ( J Issued by Date Z,&
INSPECTION
Date Work Started _6d Date Completed 9�
Comments
APPROVED;
Z .
Ins peqt.6f Date
SANITARY LATERAL & EXCAVATION PERMIT 2 yz- 015 0
.:} INSPECTION REQUEST
DATE OF REQUEST:- TIME.-] fD
BY: en c�� � FOR LOCATION:.T C k S
DAY INS PEC. NEEDED 6� TIME: 7
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT NO G&1570 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO, ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSPs
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
I
� ems.•-�9' Soi G
AREA OF" .CONCERN: .
SPECIAL INSTRUCTIONS: