HomeMy WebLinkAboutDrain Layers Permit Felt Road - Main Sew i"c'i''-isf.'L' i. ... _r,»tey,S;.��' ;;• , .g.. .;a..
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r-` TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DATE: �S
Pursuant to written applicad n, permission is hereby granted tol Me Licensed Dram Layer named herein to
Perform work at 1�'l'g ►� S',•,t, 4.• Lot 0 =as indicated below, at
Premises owned by ,C,,IGgV.4 whose address is Z✓ �� r/ray - and
to Lay House Drain , Repair House Drain Lay Main Other for =
occupancy or use, with acres.
Type of Sewage to be connected under th/s permit.- SANITARY SEWAGE INDUSTRIAL WASTES(l,
OR O Connection wi//be made with 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.
Pro osed start date `
p �j T.5� Estimated time for completion
Permit is to be issued to n re 01 v r csr the holder of Dram Layer's License No.
4ME/Z . Only Only holders f P1, P7 & W9 license .will be issued permit. een' wi//expire thirty (30)
days after date of issuance The undersigned Drain Layer hereby agrees to all the terms anbl conditions set
forth in the permit and the reverse side thereof. Applicant has received Town Street Excavation Permit No.
-and/or ConnDOT Permit No. =
Signed —�� r .
Li erased 9FO Layer
t
FOR TOWN USE ONLY
Permit Fee Paid$ r. (Check No.)_�
Y N Connection Charge $ (Receipt No.) w Dated
Insurance on File
Bond on File 0() ( ) This permit is hereby issued toy the above named Drain Layer who Has a valid
license issued by the SOW of Cawwcti W and has on file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement O ( )
Record of Sewer q
Assessment ( I ( 1 Issued by Date
1_
INSPECTION
Date Work Started .J-9 5 Date Completed
Comments &=L 24.
APPROVED:
spector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST': /� �2- �f" � TIME:
'BY: �� �� J�/��� FOR LOCATION: f ✓hi/ ��, c>
- DAY INSP.EC. NEEDED /O 7t!�' TIME:
TYPE' OF -INSPECTION: 7
( D4--) S ITARVLATERAL' ('PERK17,, Nd. !} (` ) FOOTING.DRAIN-':.:_
( ) EXCAVATION (PERMIT:.NO. } ( }, OTHER
INSPECTIO -REPORT«
#. DATE: - TIME: 6 INSP
• CONTRACTOR":'. _.
WORK IN PROGRESS
2LZI 2L
` f
.AREA OF CONCERN:
SPECIAL INSTRUCTIONS: