HomeMy WebLinkAboutDrain Layers Permit 19 Cody Circle t t
N1 6314
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to written application, permission is hereb gra red to the Licensed Drain Layer named herein to
perform work at / Lot#4;tas indicated ,premises owned by a o won sY whose address is �"S S.(/C� and
to Lay House Drain , Repair House Drain Lay Main , Otherfor f•? �l
occupancy or use, with V acres. �—
Type of Sewage to be,connected under thisp ermit: SANITARY SEWAGE 1, 1NDUSTRIAL WAg7ES l_ 1 OR () Connection will be made'with l Al/
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
indicated on the back of this permit.
Proposed start date Estimated'time for comp/eiron
Permit is to be issued to To k el ;�j r Q o dps the ho/der of Drain Layer's License No.
2O$12 il 4 Only holders of P), P7 & W9 licenses will be issued permit.. Permit will exo/re thirty (30)
days after dateof issuance. The undersigned Drain Layer hereby agrees to al/ the terms and conditions set
forth in the permit and the reverse side thereof. Applicant has recem Town treat Excavadpn Permit No.
_ and/or ConnDOT Permit No.
Signed
t ceased ain L r
FOR TOWN USE ONL Y
Permit Fee Paid$ 1 (Check No.) d 6,rT'6
Y N Connection Charge S &0 (Receipt ftd (_3 H Dated
Insurance on File (N ( 1
Bond on File fl(1 ( 1 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 file, satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement ( 1 (
Record of Sewer 11473/�
Assessment ,( 1 ( l Issued by D e g�G-,9
� �-
INSPECTION
Date Work Started Date Completed ' — /g-9 S
Comments
APPROVED: Of
nspector Date
SANITARY LATERAL & EXCAVATION PERMIT
K INSPECTION REQUEST
DATE. OF: REQUEST: ��� y� TIME:
BY: 20��i ` FOR LOCATION:
DAY. INSPEC. NEEDED �� TIME:
TYPE70F INSPECTION:
(
SANITART-IL TERM =(`PERMIT`,NO': 7a� ) ( ). F'l00T;ING..DRAI,N, .
a
( ) EXCAVATION (PERMIT NO. ) ( } OTHER
s
WSW 0WREPOR ,
(.. DATE: �p "�s TIME INSP:
r CONTRACT QIZ._'R .�" WEI4THER' Oat
WORK IN PROGRESS: , '�C�� !(1/ " !/• r o
AREA OF CONCERN:
SPECIAL INISTRUCTIONS: