HomeMy WebLinkAboutDrain Layers Permit 40 Leah Lane 60
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT'
DATE: h /
Pursuant to writt p alooTzip fission 's hereby granted to the Licensed Drain Layer named herein to
erform work at a
p e �--� of# S"' f�dcat below, at
premises owned by whose address is 6/6 — t/ : and
to Lay House,Drain Repair H use.Drain' Lay Main Other for
occupancy oruse, with acres.
I Type of Sewage to be connected under this permit.• SANITARY SEWAGE , /NDUSTR/A Xff!)
OR fl Connecgbn will be made with �' .4l/
work to be in accordance with Town of South Windsor standards, a//OSHA requirements and the conditions
indicated.on the back of this permit �?
Proposed start date b' Estimated time for don
Permit is to_be issued to Ci� the holder of Drain Layer's License No..
Only holders of P1, P7 & W9 licenses wi//be issued permit. Permit will expire thirty QW
days after date of issuance. The undersigned:Drain Layer hereby agrees to all the to ms and conditions set
forth in the permit and the reverse side thereof. Applicant has received wn Stree vat/on Permit No.
and/or ConnDOT Permit No.
Signed
Licensed Drain Layer
FOR TOWN USE ONL Y
Permit Fee Paid$ z (Check No.1 _f-7s'6
Y N Connection Charge /c�s"'y 3T (ReceiptNo.l 1cy3ir Dated ?
Insurance on File ( ( l
Bond on File (.�/'( I Thi=Oi
it is hereby issued to the above named Drain Layer who has a valid
licez by Me State of Connecticut and has on file,s��bond
Premises subject to and insurance in the name of the Town of South Windsor. a
Intertown Agreement ( 1
Record of Sewer
Assessment l O Issued by Date < fa
INSPECTION
Date Work Started a- 4e /Asr Date Completed
Comments
APPROVED:
Inspe or Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:
BY: fzo.-v FOR LOCATION: _s—
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. a-V-59 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS: S:p� l.sl•
"ram t c; i✓C"C�.�� �t�� �! ��i
AREA OF CONCERN:
SPECIAL INSTRUCTIONS :