HomeMy WebLinkAboutDrain Layers Permit 90 Heatherwood Drive N2 6404
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S ERMIT �s
DATE:
Pursuant to wri en pplic Lion, perms sion is hereby granted to the Licens�g Drain Layer named herein to
per,
work ate , Lot# as indicat d¢slow, at
Promises owned by whose address is and
se awk, ai er
occupancy or use, with j acres.
Type of Sewage 0 be connected under this permit.• SANITARY SEWAGE. tK INDUSTRIAL WASTES 1),
OR t 1 Connection will be made with � All
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
indicated on the back of this prermit.
Proposed start date fu,`7 j ,,;; Estimated time for completion
Permit is-to.,be issued to ,'
the holder of Drain Layer`s License No.'
"1 Only holders of P11 P7 & W9 I' anses will be issued permit. Permit will exaire thirty (341
days a"her°date of issuance The undersigned rain Layer hereby agrees to all the terms and conditions set
forth in the permit and the reverse side thereof. Applicant has received To Street Excavation Permit No.
andfor ConnDOT Permit No.
cen i ayer-
FOR TOWN USE ONL Y
Permit Fee Paid$ o1 5 •°y (Check No.) / //'L 1
Y N Connection Charge $ 66o. 00 (Receipt No.l �(66 y""' Dated
Insurance on File t y'( I
Bond on File This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Convrectiicvt and has on file, satisfactory bond
Premises subject to and insur' in the name of the Town of South Windsor.
IntertownAgreement
Record.of Sewer
Assessment ( I l) Issued by. -fi919>? Date 3 'ZY,9(,
INSPECTION
Date Work Started Date Completed m ,r/p!
__Comments
APPROVED:
` �� � _ gs, AC
�Insp ctor Date
w SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
-DATE OF REQUEST': ���..� 1� TIME:` q - - -
, 1
BY; c e FOR LOCATION: 9O �1eQ'�i�ES�L�XJU
.'DAY INSPEC . NEEDED TIME:
l` TYPE.`OF INSPECTION:
SANITARY/LA:TERAL�'.(.PERNIT-LNG." GL40q }: (;. }. FQOTING' DRAIN.;;.:
( ) EXCAVATION (PERMIT NO. } ( } OTHER
If4SP ECTn0I%.,REPO r..:
t 1DATE:" dyMor/9er TIME: /,oa "-iz-oo INSP: y, G��i�.✓�-
CONTRACTOR. ' "J"i*7:7r WEATHER:
WORK IN PROGRESS:
d.o s��.yL S�.rrs�6.�T/.v sr.rl�s �m.eb �s �•�av�sr.� a.�
-
.f/e vor <afwyri�.�/ r�®.y�r/OHP���' �✓«G s.��✓
GB•C/1B'G� o�.v.r iAi✓ Ot✓ �S d'N/6 T
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: