HomeMy WebLinkAboutDrain Layers Permit 63 Hollis Road TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERM
-- DATE:
Pursuant to written appticatton, permission is hereby granted to the Licensed Drain Layer named herein to
perform work at Lot# as indicated below, at
premises owned by, ." whose address is and
to Lay House Drain, Repair House Drain , Lay Main , Other , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE O, INDUSTRIAL WASTES l),
OR f) Connection will be made with a 1-' < All
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
indicated on"the back of this permit.
Proposed start date Estimated time for completion
Permit is to be issued to the holder of Drain Layer's License No.
Only holders of P1, P7 & W9 licenses will be issued permit. Permit will exoire thirty (S®)
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 thereof. Applicant has received Town Street Excavation Permit No.
and/or ConnDOT Permit No. r
Signed
Licensed Drain Layer
FOR TOWN USE Oft Y
Permit Fee Paid $ s (Check No.)
Y N Connection Charge 2Receiot No) > Date
Insurance on File fr ) O f
Bond on File ( ) ( ) This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on File, satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement O ( )
Record of Sewer f7 , L '
Assessment O O Issued by ''` - ' Date '
INSPECTION
Date Work Started 0 %-�i Date Completed
Comments
APPROVED: A
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
c� INSPECTION REQUEST
DATE OF REQUEST: /`� TIME: 1 Z�-
BY: Alv. FOR LOCATION: (O3 A&, 42
DAY INSPEC . NEEDED "r! TIME: 1Q f
TYPE OF INSPECTION: // /
(SANITARY/LATERAL (PERMIT NO. (fi L } ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( } OTHER
INSPECTION REPORT
DATE: . if-�; TIME: INSP:
CONTRACTOR: j /; -' / WEATHER: "
WORK IN PROGRESS: i �'i -� ` `�`Z�, �1'z -
i � /.� 6r .1iL�2.v j � "S/�"/✓��
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
APR
VIOLEiTE SILVESTER&SONS,INC.
65 Cherry Street
East Hartford, CT 06103 `-
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS OR LOT N° :
STREET:
- SUBDIVISION:
0
R i STATION :
NORTH ARROW INVERT ELEV:
TIE TIE
-FT -FT,
HOUSE LATERAL LATERAL HOUSE
CONNECTION STUB STUB ®� a CONNECTION
FT. FT.
BUILDING INV. ELEV. INV.ELEV. INV. ELEV. INV. ELEV BUILDING
(IF EXIST.) 0FEXIST.)
TIE TIE
Nti STATION : +
INVERT ELEV:
CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR(PRINT)
STREET ADDRESS SIGNATURE DATE
TOWN STATE ZIP INSPECTED BY TOWN DATE
C
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW -CONSULTING ElGlNEER/DEVELOPER