HomeMy WebLinkAboutDrain Layers Permit 419 Graham Road 'n•r-± i 'vw5r•wiard' �g R�'!j '+i'!j•'.d +l -.+^.:7' t t � ', v".`r 7sC�' .i� p 'r;. .. t -,r
6419
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to written application, permission is hereby granted to the.Licensed Drain Layer named herein to.
perform work at V1' . .o , Lot# : as indicated below, at
premises owned by C ) whose address is Si9w1 E and
to Lay House Drain 7* Repair House Drain , Lay Main , Other , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit.• SANIMARYSEWAGE INDUSTRIAL WASTES O,'
OR (l Connection wi/I be made with _ �fA#
work to be,in accordance with Town of South Windsor standards; all OSHA requirements an a conditions
indicated on the back of this permit
Proposed start date 9 Estimated time for completion-1 -L-�
Permit is to be issued to. ..Jci rlzS, the holder of Drain Layer's License No..
aG Only holders of P 1, P7 & W9 licenses will be issued permit. Permit will mire thirty ( 0)
days after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and conditions set
forth in the permit and the reverse side there f. Apprylhas r eived Town treat Excavation Permit No.
and/or ConnDOT Permit No. �
Signed _
Li ens Drain Layer
i
FOR TOWN USE ONLY
Permit Fee Paid$ Xs", Od (Check No.) 2 7 7 Z e-IM6
Y N Connection Char e S lRecel t No) Ye Dan(d_S' —�C
9 LGb. o�+ p �Y 7 -�,����
Insurance on File
Bond'on File (&6 This permit is hereby=tetof
to the above named Drain Layer who has a valid
license issued by the Connecticut and has on file, sadsfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.'
lntertown Agreement O ( )
Record of-Sewer
( I( uO-d: _ _._ _ _ _
INSPECTION
Date Work Started Date Completed yZ E
APPROVED: - - -
Inspector . Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST:��Q�� TIME:. 'mac
BY: FOR LOCATION:
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( ,�) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP:
CONTRACTOR:— WEATHER:
WORK IN PROGRESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: