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HomeMy WebLinkAboutDrain Layers Permit 11 Drake Court (2) 6379 TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAUTOF POLLUTION CONTROL DRAIN LAYER'S PERMIT --� DATE: Pursuant`to written ap licatio , per fission s hereby granted to.the Licensed Drain Layer named herein to perform wotk.at / Lot 12 indi aced bel w t premises.owried by whose address is and to Ley House Drain , ReAair House drain , Lay Main , Other r occupancy or.use.:with d acres. Type of Sewage to be connected under this.permiv SANITARY SEWAGE. ZINDUSTRIAL WASTES(1, Connection.will be-made with S ply.3 S` . A// work to be in accordance with`Town of South Windsor standards, a//OSHA requirements and the conditions indicated on the back of this permit. Proposed start date f -- Estimated#ime for compled, Permit is to,be issued to .T g the holder of Drain layer's License No ZC%w8:!�2 Only holders of P1; P7 & WS licenses will be issued pernit. ormit will expire fifty (30) days after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and condtlons c set forth in the permit,and the rOverse side thereof. Applicant has received Town Street f rcevedon Permit No. and/or ConnDOT Permit No. Signed L/c' Drai yer FOR TOWN USE ONLY / Permit Fee Paid$ s�00 (Check No.) Y N Connection Charge $ (,2 ©-Old(Receipt No.) 6 3"7 `2Dated '- 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 me,satisfactory bond Premises subject to and insurance in the name of 64m Town.of South Windsor. Intertown Agreement Record of Sewer Assessment ( 1 ( 1 Issued by Date Z e Ir INSPECTION Date Work Started Date Completed /-01-1-�6 , Comments APPROVED: I sn pector Date z SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST l © `z� TIME: . BY:— �!/I�✓ FOR LOCATION: 1 _ DAY INSPEC. NEEDED TIME: TYPE OF INSPECTION: { ) SANITARY/LATERAL (PERMIT NO. i�,37 i ) ( ) FOOTING DRAIN ( } EXCAVATION (PERMIT NO. ) { ) OTHER INSPECTION REPORT DATE: 1 TIME: � ? INSP: CONTRACTOR:-- ��d � WEATHER: WORK IN PROGRESS: d AREA OF CONCERN SPECIAL INSTRUCTIONS: