HomeMy WebLinkAboutDrain Layers Permit 296 Foster Road Air
6437
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
_DRAIN LAYER'S PERMIT
DATE: b
Pursuant to written ap�°licat/o ermission is hereby granted to.,the Licensed Drain Layer named her 7 to
perform work at _ -I 7:05.4`<� h.�D
Lot# 1 as indicated below, at
premises'owaed by +/t0 04,n, t4 whose address is
to Lay House Drain 'Repair House Drain , Lay Main , Other 1, 1NDUS
r
occupancy or use,, with acres.
type of Sewage to be connected under this permit: SANITARY SEWAGETR/AL WASTES(J,
OR{1 Connection will be made with 1� 041 C AI/
work to be in accordance with Town of South Windsor standards,al/OSHA requirements and the`conditions
indicated on the back of this permit.
Proposed start date Estimated rime for completion, 1
Permit is to be issued to ' t th ho �r of Drain U L�. �of � l ti ( .fie holder of Drain L yer's License No.
Q v? C1 Only holders of P1, & W9 Iicenses-will be issued permit. Permit will expire thirty (30)
days after date of.issuance The undYrsigned Drain Layer hereby agrees to a/i tJter;. 7,arid conditions set
forth in the permit and the reverse side thereof. Applicant has received To n Savation Permit No.
and/or ConnDOT Permit No. 06Q U. f
Signed
ens Ora,
FOR TOWN USE OK Y
Permit Fee Paid sue, .C'�a (Check No.) ro
Y N Connection Charge $G 00— (Receipt No.) 16461 Dated (;I -(
Insurance on File ( J
Bond on File This permit is hereby issued to Me above named Drain Layer who has a valid
license issued by the State of Connecxicut and has on Me, satisfactory bond
Premises subject to and insurance in the name of the To of South Windsor.
Intertown Agreement ( J611)
Record of Sewer l
fo Assessment f 1 ( l Issued by Dates /-7/A
INSPECTION
Date Work Started , f_ ,�T�. Date Completed _.
Comments 7� 'Of _
APPROVED:
Inspe r Date 01
�/
r.
01AwI i/Ani LAi MMAL Oc =AtoAVHI IUN F'tKAni I
INSPECTION REQUEST
DATE OF REQUEST: t TIME:
f
BY: �� U � 'j FOR LOCATION:_. k
DAY INSPEC. NEEDED 41'� TIME:
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. 6'ji�X7 ) ( ) FOOTING DRAIN
` ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE:_ TIME: INSP:
CONTRACTOR: WEATHER: .a.,�..✓g-
WORK IN PROGRESS :
AREA OF CONCERN: ,
SPECIAL INSTRUCTIONS: