HomeMy WebLinkAboutDrain Layers Permit Lawrence Road We 6377
TOWN-OF SOUTH WINDSOR
DEPARTMENT.OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: -21 _V 3 --
Pursuant to WrIttep application, perm/ss/o Is hereby granted to the Licensed Drain Layer named herein to
perform work at �/^ �� _^Rr,�SpiuvE,� 7r�V/ ��� dot#--. as indicated below, st
Premises owned by_._4 oc-T _T whose address is and
to Lay House Drain Repair House Drain Lay Main
occupancy or use, wirn acres:
Type of Sewage to be,connected under this permit.* SANITARY SEWAGE( lND T
OR(1 US R M WASTES(l,.
Connection will be made with S T? K.. . 5 Al/
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 /Z ��`y_ tim led time for cornp/edon - (�
Permit is to be`°issued to h the/folder of Drain Layer's License Na.
2-0 C�. Only holders of A1, P7 & W9 Ii rases will be issued permit. Permit will expire thirty 00)
days after date cf d2imace The undersigned D ain Layer hereby agrees to a//the, terms and conditions set
forth in the permit and the reverse side thereof. Applicant has received Town Street Excavedon Permit No.
Z J�and/or ConnDOT Permit Na
Signed l 9
ceased D Lay
FOR TOWN USE ONLY ,
Permit Fee Paid$ Z$ -00 (_Check No.) 144D04-
Y N Connection Charge S N , - (Receipt No.) -----.. Dated
Insurance on File
Bond on File fV!`( 1 This permit is hereby issued to the above named Drain Layer who has a valid
Incense issued by the State of Conneadew and has on_Me,s&*factory bond
Premises subject to _ / and insurance in the name of the Town of South Windsor.
intdrtown Agreement (1Il ( I
Record.of Sewer _
Assessment ( 1 ( 1 Issued by Date /`� 1
INSPECTION
f
Date Work Started ,v U Date Completed
Comments Hz � � a _�„T s
4.1
APPROVED•
/d /Z Inspector Date
SANITARY LATERAL..& EXCAVATION PERMIT
INSPECTION REQUEST
DATE'OE .NEWEST: 9
BY: FOR LOCATION:
DAY INSP.EC NEEDED jy--/L — �� TIME:
TYPE" OF ,INSPECTION..;'.
SAITzTART/LzATERAL PERMIT Ntt 6,33
f ) ( _::. �.- .FQOTIBIG..BRAIN.
( ) EXCAVATION. (PERMIT "NO. ) ( ) OAR
,1,014 REPORT,
INSPEC
INSP:
CONTRA=ORI-. WEATHER:-
WORK IN PROGRESS:— o15;1
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS:— `J 2_,_— % /���1��� lt�>41; 7/j�' �S
SANITARY LATERAL,.& EXCAVATION PERMIT
INSPECTION REQUEST
DATE-OF FFMI,IIEST.:
BY.: f FOR LOCATION:
DAY INSPEC. NEEDED If j 41-9 TIME:
TYPE" OF •INSPECTION.
( } SANITARVLATERAL (PIIZMZT`NQ: 6 3 3?-
} .FOOTING DRAIN "
( ) EXCAVATION- (PERHIT -NO.
INSPECTION,' REPOT.:•:.
DATE.:. l Z -/ ?j .,_ 5 TIME: �i'
INSP:
CONTRA=OH: �raf - i dlz i3 i � //�`J WEATHER L r?yc� /L�(��G
WORK IN PROGRESS:
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SREC IAL-::-3NSTRTZ4NS�
SANITARY LATERAL,.& EXCAVATION PERMIT
INSPECTION REQUEST
DATE'OF' .RE=ST.: TIME::
BY: :� /27� FOR LOCATION:
DAY INSP.EC NEEDED TIME:
TYPE" OF -INSPECTION.,. _
( ) SANITARY/LATER r. (PERMLT"im.- -FOOTING DRAIN.
( ) EXCAVATION- (PERMIT 'NO.
(. ) OTHER
INSPECTION" REPORT,,.,
DATE.•. __ �.; ._- -- :�/ _ �-
�5 TIME: i »l INSP• /ice
CONTRA=OR' ,/�/'�-lf %�/Ll�3i 7L WHAT=-.;
WORK IN PROGRESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
SANITARY LATERAL..& EXCAVATION PERMIT
INSPECTION REQUEST
DATE'OF REST-: TIME.:
BY: FOR LOCATION:
DAY INSP.EC NEEDED TIME:
TYPE- OF •INSPECTION:;.
( /� ) SANITARIMATMtaL (PERMIT.AQ: '377 f .- -FOOTING DRAIN•'.,i.. .:
( ) E%CAVATMW (PERMIT •NO. ) ( ) OTHER
INSPECTION- REPGRT -
DATE.: f Z % TIME: INSP:
CONTRACTOR': WEATHER:
WORK IN PROGRESS:
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AREA OF CONCERN:
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SPECIAL INSTRUCTIONS:
SANITARY LATERAL,.& EXCAVATION PERMIT
INSPECTION REQUEST
DATE'OY- .REWEST-: TIME: -
BY: FOR LOCATION
DAY INSPEC. NEEDED TIME:
TYPE" OF .INSPECTI08-
( ) SANITARY/lATERAL :(PERMIT":-NG -' �y l'
} ,:.E: ;,.. �,_:, .-FOOTING GRAIN
( ) E%CAVATI V- (PERMIT "NO. )- ( ) OTHER
INSPECT,[OUREPOFMr,
DATE.. _..=�Z. 2_.7 Y 5 TIME: INSP: '�>
CONTRACTOR:, �� /' '/"t`'���
WEATHEIT
WORK IN PROGRESS:
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AREA OF CONCERN: -
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SANITARY LATERAL.& EXCAVATION PERMIT
INSPECTION REQUEST
DATE.'OF".xffuUEST: TIME'.:
BY: - FOR LOCATION:
DAY' INSPEC.' NEEDED: TIME:
TYP.E�" OF -INSPECTION"::'_.
( SANITARY'tL mar. (PMUUT" Rff: 7 7 f E' : j= ..FOOTING:'DRAIN."
( EXCAVATIOR - -(PERMIT."NO_. OTHER
[NSPECT�fli��REP4F��' �:: •
DATES .. - /Z —2 6 �'S� TIME: INSP:
CONTRACTOR:
WORK IN PROGRESS
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