HomeMy WebLinkAboutDrain Layers Permit 40 Grandview Terrace 6398
TOWN OF SOUTH WINDSOR
DEPARTMENT OFIYBL-IC WORKS
BUREAU,OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:__ 3�i9/x
Pursuant to written app/icadon, permissi n le der y granted to the License9�Drain Layer named herein to
Perform work d •4�{j / /y{ Lot# "t as indicated be%w, of
Premises owned by whose address is 17fY �IICM 12.0
f
to Lay House Drain A Repair House Drain . Lay Main , Other. or and
occupancy or use, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE. INDUSTRIAL W;�STES O,OR O Connection wi//be made with C A C .. A//
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 -r 1 46 Estimated time for completion 4;? 1(
Permit is to be issued to the holder of Drain Layer's Y s license No.
Only holders of P7, P7 & W9 licenses will be issued permit. Permit will am.re Wiv M)
days after date of issuance The undersigned Drain Laye h reby agrees to"all the terms and conditions set
fo / the Permit and the reverse side thereof. App/ican' h s received Town Stre Ex on Permit No.
and/or ConnDOT Permit No.
Signed <
censed Drain Layer
FOR TOWN USE Oft Y
Perm/t fee Paid S -oD c�
(Check No.)
Y N Connec"o -Charge S A _(Receiptl- -- Dated 3
Insurance on File ( ( )
Bond on File (-/ O This Penn it a hereby asued to the above named Drain Layer who has a valid
A license issued by the State of G�ectft W and has on file,satisfactory bond
intertown Agreement Premises Agsubreeeeme ct to
and/nsurMnae in the name of the Town of South Windsor.
O
Record of Sewer
Assessment ( 1O Issued by Date ��
INSPECTION
Date Work Started Date 'Completed
Comments -
APPROVED:
nspectoroo0' Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:
BY: _7- r , ��.. T - FOR LOCATION: �O�
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( � ) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION {PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: �_!S- a ra 'moo INSP•
CONTRACTOR: WEATHER: ys' ' o� c�s�,•s`-�✓d¢
WORK IN PROGRESS:
_ �oit/ir/cc`CT TO f�OG�,� O
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:_ �ea�-i,✓6 dt-pia/ �Gs �- os,.�� L ��