HomeMy WebLinkAboutDrain Layers Permit 11 Drake Court N" 643®
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMTI'
DATE: S .� 9-�
Pursuant to written application, permission is- ereby granted to the Licensed Drain Layer named herein to
perform work at �" Lot# as indicated bylow, at
premises owned by 1h.—recv, whose address is and
to Lay House Drain , Repair House Drain Lay Main , Other . or fAo" /T—
occupancy or use, with ! acres.
Type of Sewage to be connected'under this-permit: SANITARY SEWAGE-
OR WTI STES(J,
OR f J -- Connection will be made with i bA 35 . :All
work to be in accordance with Town of South Windsor standards, al/OSHA requirements and the conditions
indicated on:the back of this permit.
Proposed start date Estimated time for completion
Permit is.to be issued to the holder of Drain Layer's License No
Z158 3 Only holders of P1,'P7"& W9 licenses will be issued permit.- permit will expire Mirty (Sol
days after date of issuance. The undersigned Drain Layer hereby agrees to a// the terms and conditions set
forth in the-permit and the reverse side thereof. Applicant has received Town Street Excavetron Permit No.
and/or ConnDOT Permit No.
Signed
L/cen Dra' ayes
FOR TOWN USE Oft Y
Permit Fee Paid$ ds•®o (Check
Y N Connection Charge S 600,o o (Receipt No.) nls o Dated s' i T
Insurance on File (kf,( J
Bond on File This permit is hey issued to the above named Drain Layer who has a valid
license issued by the Stage of Cmumicut and has on Erie,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement ( I ( I
Record of Sewer
Assessment f I ( 1 Issued by Date s"
INSPECTION
Date Work Started -rzzc Date Completed �'/'24 Z2
Comments
APPROVED:
Inspe or Date
SANITARY LATERAL & _EXCAVATION PERMIT
INSPECTION REQUEST
DATE"OF REQUEST: /9� TIME
BY: J�if FOR LOCATION i
DAY INSPEC. NEEDED�� �� TIME:
TYPE OF. INSPECTION:°
FOCTING..DRAIN.,
( ( } EXCAVATION " (PERMIT- NO. J ( ) OTHER
INSPEC'.n0 R.EP0R
y DATE: T�; /9 e TIME:: INSP:
.4E. CONTRP CTOR:..<`Y i"S.—1,T WEATHER:
WORK IN- PROGRESS:
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i+/mTCT 6.yS��qr/l/ L2 'JpeF2'A;21
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
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