HomeMy WebLinkAboutDrain Layers Permit 887 Foster Street ' 6424
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: S
Pursuant to written a�Qlication permission i hereby ranted to the Licensed Drain LayerLined rein to
perform work at �"� , Lot# as indicated below, at
premises owned by MA rZ,I o` G/t2a uX whose address is < A-h and
to Lay House Drain -�•, Repair House Drain Lay Main Other , for
occupancy or use, with acres.
Type of Se"wage to be connected under thi permit. AN/TARY.SE O,
OR O , /NDUSTR/A TWA TES(h
onnection will be made with 4 Ail
work to be in:accordance with Town of South Windsor standards, a//OSHA requirements and'theconditions
indicated on.the back of this permit.
Proposed start date 3 a Estimated dyne for comp/edon
Permit is to be issued to.ro 1.,A Ca^,) � � l A C the holder of Drain Layer's License No.
Only holders of P1, P7 & W9 licenses will be issued permit. Permit will ex
oire thirty (301
days after date of.issuance. The undersigned Drain Layer hereby agrees to`aff Pe, terms and conditions set
forth in the permit and the reverse side thereof p l/cat has received To treat Excavation Permit No.
and/or ConnDOT Permit No.
Signed
Lic red in ayes
FOR TOWN USE Oft Y
Permit Fee Paid$9 5 (Check No.) I�rc•' C��t2
Y N Connection Charge $ (:Qa O u (Receipt No.l Dated•
Insurance on File (+/f( I
Bond on File C,4( I This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has or file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertownAgreement ( l ( 1
Record of Sewer
Assessment _ . . . lesua b
Date --y -s<-
1-01
INSPECTION
Date-Work Started 1; C / _ Date Completed
Comments
APPROVED:
Insp or Date .
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:
BY: FOR LOCATION:
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
SANITARY/LATERAL (PERMIT NO. GY0 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP• a-
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
O ee
5!'ZS .o/'A iF°✓�s %-o �r Cc9 s-rP� eS'` s-=r,---
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: