HomeMy WebLinkAboutDrain Layers Permit 411 Graham Road Noe $
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT DATE:
Pursuant to wr a appli tion, p rmission,,js hereby granted to the Licensed Drain Layer named herein to
perform work at �� < V QG , Lot#' as indicated a w, at
premises owned by p, Li b J whose address is �f//�("ee'c'. X r� and
to Lay House Drain .�., Repair House Drain , Lay,Main other , for
occupancy or use, with 31,E acres.
Type of Sewage to be connected under this permit.�SANlTARY SEWAGE. N, /NDUSTR/AL WA TES(1,
OR(1 N ,,r �sv� Connection will be made with ..3o3Y l�L 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.
Proposed:stet#date fo F Estimated time for comp/etion J
P,ermlt.ls.to be issued to ! -t" �f, t/re holder of Drain Layers license Na:
Only holders of P f, P7 & W9 licenses will be issued permit. Permit will expire thirty /3QJ
ems,a of.„ sg�nce.. The undersigned.Drain Layer hereby agrees to all the terms and conditions set
forth'hi: ` rmit and the reverse sid8 thereof Applicant ha ,cei Town meet cavatron Permit No.
nd/or ConnDOT Permit No.
Signed
censed Drain Layer
,.
FOR MKW USE ONLY
Permit Fee Paid$ c25.oy' (Check No.) c ro
V N Connection;Charge S L� 60 (R,ece/ptNo.) Hs 6 Dated I is
lnsurance on File
Bond on File t V( 1 This permit�sr-hereby issued to the above named Drain Layer who has a valid
/cehse issued-by the State of Ctar�necgmt and has on Me,se sfactory bond
Premises subject to: and insurance in he name of the Town of South Windsor.
lntertown Agreement
Record of Sewer
��
..INSPECTTON
Date Work Started /Z—28 'g5 Date Completed
APPROVED,
Ao
Inspector Date .
JAr4l tAtiY.LAl.ttUM_do txt:AVATIUN PERMIT
INSPECTION REQUEST
DATE'OF-.RE=ST.:
BY: GC�lJs �{I�-G FOR LOCATION: ZZ22V-
' DAY" INSPEC NEEDED: Imo'" " 9✓ TIME: 1�0V
TYPE.. OF .INSPECT-ION: '_
1� SANITARFtLATER= :(PERMIT NQ - s I E ) ' FOOTING-;
EXCAVAT.M PERMIT-VO.
...._:. �.. OTHER-
�4
INSPECT#fliVREP
DATE,. - r Z-7 Q'_ TIME: INSP:
CONTRA=OR': WEATHER~`
WORK IN PROGRESS:.. ` t- r~'
/���l/fr�2J /-✓�(Z��-. jam'i�y�'�.s
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: