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HomeMy WebLinkAboutDrain Layers Permit 33 Leah Lane -r. - wRs+�tr�.- ....�. _ .n.• �. '4fk"aa:A?`.'°' �.ph x�,7V't:{;...;.a,vv r s 6_385 TOWN OF SOUTH ArMSOR DEPART OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT DATE: Pursuant to wr en appli ado permis ion is herebygranted to the Licensed Drain Layer named herein to perform work at wl. M6 �_ Lot# as fn��//c tad fo at Premises owned by v a whose address is 1/(' N, i e,(M.--.nd to Lay Howse ©rain Repair Hou.e Drain La Main occupancy or use, with acres: i Type of sewage to be connected under this permit. SANITARY SEWAGE. , 1NDUSTRIAL WASTES(1, OR,{1 Connection will be made I with `'p1/L.._,. -Al/ work to Fe in accordance with Town of South Windsor standards, a//OSHA requirements and the conditions indicated.on the back of this permit. Proposed start date - P ,estimated dme for comp/edon Permit is to.be issued toy& 7 the holder of:Drain Layer's License Na. Only holders of P1, P7 & W9 licenses will be issued permit. Permit will exvfre,Mirty (30) days after date of&Awnce. The undersigned Drain Layer hereby agrees to a//the terms and conditions set forth in the permit and the reverse side thereof. Applicant has radvi9d Torun Siree cavadon Permit No. and/or ConrDOT Permit No. Signed licensed Drain Layer FOR TOWN USE ONLY Permit Fee Peid 5�,, (Check Nod Jr Y N Connection-•Charge $ ,OSB 3 (Receipt No.) Dated /2 Insurance on Fife Bond on File (1(J O This perirnit/s her*by.issued to do 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. fntertown Agreement A ( I lzxw11 o`er V-cc,V%o V-6 ii C-4s7 Record of Sewer Assessment ( l l I Issued by Date /Z Z8 S"' INSPECTION Date Work Started / - ! Date Completed /Z=219-^45� Comments APPROVED: is Inspector Date SANITARY LATERAL,.& EXCAVATION PERMIT INSPECTION REQUEST DATE'OF .RE h=ST TIME: BY: FOR LOCATION: DAY INSPEC NEEDED. /, -Z TIME: TYPE_ OF .INSPECTIONt- �-- SANITARTIL TERAL : PERT--No. �_ ��-=� �� ) (` -- FOOTING, DRAIN - . .. . ( ) EXCAVATIM (PERMIT -NO. _ OTHER INSPE, N xF�EfaOF�T •.. . . :_ DATE.,. � -2r v� <_ y- _ ' v TIME• %��1,� INSP /�_Xj CONTRACTOR• 1' ?WORK IN PROGRESS:- 7 4,-& -- r�-C�GG �%��iz-'L �� /3�'� �>�--Tz c"' /� L= %� � j �•�. -- /f-� C � �L'�s� �L�> 4� AREA OF CONCERN: SPECIAL INSTRUCTIONS: