HomeMy WebLinkAboutDrain Layers Permit 142 Graham Road , .:.... .-„ .a<.,;;•[«`�+°"`$�iie-vy ..i-...,,...,�;f.^v9T(;:7Tz'.rNF'ee:m+yy'F s^.5`7Y^.�7`9T.!�{4 .s ri z x."Y, .. dv�-•-r s - i. 7 .i i� ��
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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to written a A is hereby granted to the Licensed Drain Layer named herein to:
perform work at_ �c ,,p_�WIN , Lot# es indicated be%w, at
premises owned by whose address is Sir and
to Lay House Drain Repair Ho se Drain , Lay Main , Other , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit. SANITARY SEWAGE, INDUSTRIAL WASTES(1,
f OR (1 Connection will be made with All
work to'be in accordance with Town of South Windsor standards, a//OSHA requirements and the con(ftions
indicated on the back of this permit.
t�
Proposed start date - C... / E imated dme for comp/etion ��✓
' !Ahoj?ds Permit is to be issued to r thr of rain yer's License No.
Only holders of P1, P7 & W9 licenses will be issued permit:" Permit will expire thirty (30)
days after date of issuance. The.undersigned Drain Layer hereby agrees to a//the terms and conditions set
9 sflo in#h rmit and the reverse side thereof. Applicant has received To n Street Excavedon Permit No.
5(�d/or ConnDOT Permit No.
Signed
Licensed Drain.Layer
FOR TOWN USE ONLY
Permit Fee Paid$65-00 (Check No.) E&S 8
Y 1\/N Connection Charge $CCYJ.O� (Receipt No.) U-Sgo Dated -2q-R5
Insurance on File (Vi
Bond on File (V( I This permit is hereby issued to the above framed Draw Layer who has a valid
Ikense issued by the Stage of Conner cut and has on file,saftfttory band
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement (I
Record of Sewer
-Assessment—_ Issu. ed-bv
INSPECTION_
Date Work Started Z ,0,5 Pis Date Completed
APPROVED:
Inspector Date
5ANITARY.LATERAL..& EXCAVATION PERMIT
INSPECTION REQUEST
DATE"OF".REQIIEST.: f.Z 0 7- TIME:
BY: 77-, 12, FOR LOCATION:
DAY" INSPEC. NEEDED: TIME:
TYPE"" O€ .INSPECTZOHt;
( r y SANITARTtIXPERAL lgEM=` 7 ) '..( :. -FOOTING.-DRAIN." ..r,....
( EXCAVAT= (PERMIT -NG. ) ( ) OTHER
INSPECTION,-REPORT
DATE,: "".. ' =_I'Z '�O f TIME: /'i"� INSP:
CONTRACTOR:'
WEATHER � �
WORK IN PROGRESS
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: