HomeMy WebLinkAboutDrain Layers Permit 8 Nutmeg Road (4) a nwZt., ..' .e,"ay+9t?S�f. -'+;".: f�. .ry•sx` +': �':^p.'yT^"/. ,ss�'l.-an'�'."""^s'3i�.4. S
' 6376
TOWN OF SOUTH WINDSOR
" - DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
V I
DRAIN LAYER'S PERMIT
DATE:: 9
Pursuant to wren application, permission is hereby granted,to Licensed Drain Layer named herein to
perform work at y �� �,`Go nip/sf v11 Lot#_as indicated below,�at
'-r'premises o*'ed by whose address s ,,5 IV&-t- ..e$ Rol, and
to Lay Hotfsg Drain , Repair House Drain , Lay Main , Other for
f: occupancy or u§e, with acres.
Type of Sewage to be connected under this pernpit.• SANITARY SEWAGE(), INDUSTRIAL-WASTES!J
OR ' 'Pgai,��L- .cx v�-�ivDv� 2r�J'Co�`ntdittie rction will be made with to v �A I/
work to be in accordance with Town of South Windsor standard aI/OSHA requirements and the-conditions
indicated on the back of this permit. LT- y 40AvnZ ,J
Proposed start date_f r` r Estimated dme for comp/etion / �`S
A r it is -ttf.be issued to r 1Jn e_S' the ho/der.of Drain Layer's License No:
Only holders o 1 P7& W9 licenses;will be issued.permit Permit w/l/exaire th/rty.(3dJ
d"vs:after Dare ossuance. The undersigned Drain Layer hereby agrees to a//tfie farms andndtions sbt:
for( m the p¢¢rrnit and the reverse side thereof A4ignd
ant has received Town Street Excavation Permit No.
dlor Bann T PermAS�No. .f• - +, ;
C� c�s-use
_
Licensed Drain Layer
' FOR TOWN USE ONL Y
Permit FePaid S Z ,O �e (Check No
Y N Connection Charge $ (Receipt No.) Dated -
lnsurance on File (Nr( J (�iN D w Dot b -a*,)
F
Bond on File (+/J( J This permit is hereby issued to the above named Drain Layer who hae a valid
license issued by the State of Connecticut and has on file, saftfacOwy bond
Premises subject to and insurance in the game of the Town of South Windsor.
Intertown Agreement
Record of Sewer
Assessment ( J ( J Issued by
f
INSPECTION
i
Date Work Started '7- 4 Zg"9S Date- Completed
Comments
APPROVED
Inspector Date
SANITARY LATERAL.& EXCAVATION PERMIT
INSPECTION REQUEST
DATE"OF -REWEST.: % - r3 TIME-: ifs:
BY: FOR LOCATION:
DAY INSP.EC. NEEIIID TIME:
TYPE" OF INSPECTIONt-.'_
( ) SANITARFtLATERAL (PERMIT':,
�
( ) EXCAVATrQA_ (PERNIT "NO. } ( ) OTHER -
INSPECTtflN-xREPORT,
DATE.: / `C6' TIME: / t INSP:
coNTR WEATHER. ltx'
WORK IN PROGRESS
7v-1f)
i
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: