HomeMy WebLinkAboutDrain Layers Permit 35 Cody Circle 1.'„-� ,�.tc:--riff`$�t .,,..•lrz.3R:'fP?�<;. .. .,. .. R`f..affil'As�':Yi4'g'''-x.�"°�f.t..S' s4'�#`:. s'^Svc. pr:sF,s S;tl: "'k7'Tq-.�"{�"'�"�,�.nr i ,
6337
TOWN OF SOUTH WDMSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: 91=Z 0
Pursuant to written appl/cati n, ermission Is ereby granted to the Licensed Drain Layer named herein to
perform work at _ LA , Lot 02. - as ' d/cat�below, at
premises owned by v S whose address is , and
to Lay House Drain Repair House Drain , Lay Main Other or
occupancy oruse, with acres.
Type of Sewage to be:connected under this permit.• SANITARY SEWAGE. tVJ, /NDUSTRIA STE
OR (1 Connection will be made with ' Al/
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
indicated on.the back of th/s permit
Proposed start date "-1 Estimated time for completion
Permit is to be issued to '� S `holder of Drain Layer's License No..
Only holders of Pi, P7 & W9 licens s will be issued permit. Permit will expire thirty (301
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. Applicant h ece/ ed.T n Street Excavation Permit No.
and/or ConnDOT Permit No.
Signed
Uc2r Dr n Layer
FOR TOWN USE ONLY
Permit Fee Paid $ a5.00 _(Check No.) 6(Aq
Y N Connection Charge $ Goo,0 (Receipt No.) 4-1715 Dated ` 5
Insurance on File (vl ( )
Bond on.File 611 ( I This permit is hereby issued to the above named Drwn Layer who has,a valid
license issued by the State of Conte fait and has on file,sadsfactwry bond F
Premises subject to and insurance in the name of the Town of South Windsor.
/ntertown Agreement ( i
Record of Sewer '
Assessment ( l ( I Issued by r(j%j Date js S�
r
INSPECTION
Date Work Started Date Completed
Comments
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: �— - I-S TIME: 11,1115
BY: FOR LOCATION:
DAY INSPEC . NEEDED TIME:_ f
TYPE OF INSPECTION:
( X ) SANITARY/LATERAL (PERMIT NO. �3 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: _ TIME: 5; Q C7 INSP: 6err
CONTRACTOR:— WEATHER
o IL4Td o
WORK IN PROGRESS: �C
- Zo -
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: