HomeMy WebLinkAboutDrain Layers Permit 2033 Ellington Road :, �-'.. .._ �1_•:. -;.:.;.t -tiff•- '.E p_` ..}.-. {
6445
TOWN OF SOUTH WINDSOR {
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERNIIT
DATE:.
Pursuant to written applicat'gn, p missio i hereby granted to the Licensed Drain Layer named herein to
perform work at 033 t t Lot# es ihdicated be%w, at
premlsesownedb, yOWO whose address is 4 Z and
to Lay House Drain +• , Repair House Drain , Lay Main Other , for
occupancy or use, with 1 acres.
Type of Sewage to be connected under this permit. SANITARY SEWAGE ff,, INDUSTRIAL WASTES!I,
OR-0 I Connecdon 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 this permit.
Proposed start date ei q Estimated time for comp/edon J
( SzwCx E , �uc
Permit is to be issued to L �4v t2 v _ the of r of Drain Layer s license No
OUZO13'S4 Only holders of P1, P7& W9 licenses will be issued permit. Permit will exolre thirty (30)
days`after. date of.&IOnce. The-undersigned Drain Layer hereby agrees to all the terms and conditions set
forth in the permit and the reverse side thereof. Appl/caAhnareceived Town Street Excavation Permit No.
andfor ConnDOT Permit No.
Sign
Licensed Drain Layer
FOR TOWN USE ONLY }
Permit Fee Paid S 2!^-0 0 (Check No.) S C--
Y N Connection Charges 600,00 (Receipt Nod Dated
=779-2-
Insurance on File
Bond on File I This permit is hereby issued to the above nmed Drain Layer who has a valid
license issued by the Slate of Gbcdcut and has on he,mftfttwy bond
Premises"subject to and insurance in the name of the Town of South Windsor.
intertown Agreement
Record of Sewer
Assessment ( 1 t I Issued b Date
INSPECTION
Date Work Started 4-/:9 lee- bate--Completed —9
Comments
APPROVED. C�
Insp�= or���� Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST,
f �
DATE OF REQUEST: I TIME: f
BY: FOR LOCATION:
Jr
DAY INSPEC. NEEDED 6f( C - - TIME: C -
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. tUd4. ) ( } FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) _-OTHER
INSPECTION REPORT
DATE: TIME: :` v INSP: r- r -�✓
CONTRACTOR: .5"Z WEATHER:
WORK IN PROGRESS:
Az
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AREA OF CONCERN: .
SPECIAL INSTRUCTIONS: