HomeMy WebLinkAboutDrain Layers Permit 2152 Ellington Road }
6350
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
_DRAIN LAYER'S PERMIT
DATE: 9�
Pursuant to written application, permission is hereby granted to the.Ucensed Drain Layer named herein to
Perform work at v? S` f_//4 )� -_)4 A0 Lot#_ as indicated below,-at
Premises owned by whose address is and
to Lay House Drain , Repair House Drain , Lay Main 4,— Other , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE. O, INDUSTRIAL WASTES t L.
OR f 1 5^�� j��✓ ��,,. ,,.� Connection will be made with All
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
ind/cated on the back of this permit.
Proposed start date Cvee d,C Srd'y Estimated time for completion
Div ou 4FI_ 'T7F
Permit is to be issued to a ho/der o rain La01Vyer's Lioense No..
Only holders of P1 7 & WB licenses will We issued.permit. Permit will exvire thirty t 0)
days after date of issuance The undersigned Drain Layer hereby,agrees to all the. terms and condNons set
forth in the permit and the reverse side thereof. Applicant has received Town Street Excavation No.'
end/or ConnDOT Permit No.
. Signed
Ucensed Drain Layer
FOR TOWN USE ONL Y
Permit Fee Paid$ e95.00 (Chock No.) �l
Y N Insurance on File Connection Charge $ G4o.aa (Receipt No.) t -ssQ Dated
(MJ( 1
Bond on File (vI ( 1 This permit is hereby issued to the above named Drain Layer who has a valid
Ikense issued by the State of Connecftut and has on file,satisfactory bond
Premises'subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( 1 ( l
Record of Sewer /
Assessment O O Issued by Date l(V z(a/
INSPECTION
Date Work Started Date Completed /o Z7-gy
Comments
APPROVED:
22 v -q�
Inspector Date
SANITARY LATERAL..&.EXCAVATION PERMIT
INSPECTION REQUEST
DATE`OF REQUEST: �,3' - C� ' TIME. n(Mf)
,- BY: c1c ���5 � ��� FOR LOCATION:
DAY INSPEC. NEEDED 1a la TIME: 1O;00 pi`(\
z TYPE- OF INSPECTION:
( SANITARTMATERAI;.- (PERMIT`:''NET: ` . 5 £OOTING•DRAIN..
( ) EXCAVATION (PERMIT NO. ) ( ) . . OTHER
INSPECTION; REPORT
f DATE: TIME: /p I N S P
£ONTRA.CTQR':'
WORK.IN. PROGRESS
✓,ram-�v�� C�r�--z �.�-� ��,���� ���/l� ,/�s%-JC� �`'.��� :..
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: