HomeMy WebLinkAboutDrain Layers Permit 1810 Main Street _i r.i' •-;r.:.-,q�7Fi•;•y...�.,�-..,-r'..yv_..mar?aCtu'6:^*f;wba??{?".,�:.c:'.?rc:•: '4c-;f3.4}....; ,. � t� i _
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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT DATE:, 1A !3�2
Pursuant to written agpfication, permission is here 4Lgranted to the Licensed Drain Layer named herein to
perform work at !F2 r , Lot# as indicated be/ at
premises owned by ,p,+91z "" whose address is / � � and
occupancy or use, with acres.
Type of Sewage to be connected under this.permit: TAR SEWAG , INDUSTRIAL WASTES(.0
OR O 4onnec o wi a made with �' '� 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 _ �, '� Estimated time for comp/#lion
Permit is to+b!e issued to -4 the holder of Drain Layer's "License No.
Zj.:O Only holders of P1, P7 & W9 licenses will be issued permit.. Annit will exvire d1/rtv (30)
days a er 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 re e/ved Town Street Excavation Permit No.
and/or ConnDOT Permit No.
Signed
UceqaW Drain Hayer
FOR TOWN USE ONL Y
Permit Fee Paid$(95 w (Check No.) Cqsh
Y N Connection Charge $ (Receipt No.)$ 6OU.O0 Dated C- 3
Insurance on File (✓ ( I
Bond on File M) O This permit is hereby issued to the above naffed Drain layer who has a valid
license issued by the State of Connecticut and has on Ne,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
/ntertown Agreement F I (4
Record of Sewer /
Assessment O O Issued by Date
INSPECTION
d
Date Work Started Date Completed �j�►J 9l
Comments -- -- -
APPROVED: `
V
Inspe9eor Dat
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUF'�ST: �`-I�/- �� TIME 36
BY: ��U� C FOR LOCATION:,_
DAY INSPEC . NEEDED � ,(� TIME:—
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. G4ga- ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: i `gam TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS: /
C" Z o✓ S%sic- o /.le dS�' _ l���. a.
y.` fo 'Y'20 '/� i.� �r-./��2 s-�,,ux . � :��as�. .-� ��.��c .c�.�s -� �' �•
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: