HomeMy WebLinkAboutDrain Layers Permit 46 Farmbrook Lane N 6390
TOWN. OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU,OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to wF17C.=r.
ion, permission is Hereby granted to the Licensed Drain Layer named herein to
perform work at Lot# as indicated below, at
premises owned by ` 14Cff .N whose address is01
and
to Lay House Drain
1 Repair House Drain Lay Main Other , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE,*, INDUSTRIAL WASTES(J,
OR{1 Connection will be made with A#
work to be in accordance with Town of South Windsor standards,all OSHA regruirements and the conditions
indicated on the back of this permit.
Proposed start date .2�-Z6L96 k'stimated-time for completion SAwe �Af/
Permit is-to be issued to fsd e ,Cj a !or the ho/der of Drain Layer's License No.
'. Only holders of P'i, P7 A W9 lice ses wilfbe issued permit. Permit will expire thirty 1301
days after date of issuance. The undersigned Drain Layer hereby agrees to aff the terms and conditions set
forth in the permit and the reverse side thereof. Applicant has received Town Street Excavation Permit No.
-7069 7 and/or ConnDOT Permit No. ,, w
Signed �'� /�►sf,G.�
uce s Layer
FOR TOWN USE ONLY
Permit Fee Paid$ (Check No.) CQ-5V1
Y N Connection Charge $ 0,00 (Receipt No.! °tl Dated /-3/-
Insurance on File (y'f I
E -
Bond on File (W-0 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 file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( 1 ( >
Record of Sewer y
Assessment ( 1 ( J ' Issued b Date /
--INSPECTION
Date Work Started 9 G Date Completed
Comments
APPROVED.
/ 3 7 Z Z/, -�
Inspector Date
SANITARY LATERAL & EXC:AVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: �`z� � TIME: j`
BY: �� FOR LOCATION:
DAY INSPEC . NEEDED y���l TIME:
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. &3 f0 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE TIME: /! INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS: lLl.-x�� w �/Lr� /ZL7�So•✓/�dGL
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AREA OF CONCERN: .
Y SPECIAL INSTRUCTIONS:
z .