HomeMy WebLinkAboutDrain Layers Permit 19 Oakland Road . 4q it.v^ :{x
NP 6381
h TOWN OF SOUTH VWIN SOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYERS PERMIT
DATE: 1 ?
Pursuant to written application,permission is hereby granted to'the Ucensed Drain Layer named herein to
Perform work at 19 Lot# as indicated be%w, at
Premises owned by N0- whose address is and 1
to Lay House Drain , Repair HouseDram_ Lay Main , Other for
occupancy or use, with ' acres:
Type of Sewage to be connected under this permit: SAN/TARY SEWAGE. INDUS MIA L WASTES 11,
OR 11 Connection will be made with q//
work to be in accordance,with Town of South Windsor standards, all OSHA requirements and the conditions
indicated on the back of this permit. -
Proposed start date Z
i�stinrated time for comp/etion f
Permit is Q be issued to the holder of Drain Layer.Is License No
20SAft Only holders of Pli 7 & W9 licenses will be Issued permit, rmit will I 'exn re th rtv l3DJ
days after 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 s received T Street Excavation Permit No.
and/or ConnDor Permit No.
Sign ;
Ucens Drain Layer
FOR TOWN USE ONLY,
Permit Fee Paid$ Zy (Check No.) / /
Y N Connection Charge $ G v�o —" (Receipt No.) _ 6�3' g Dated /-z%- s
Insurance on File mSl ( J
Bond on file (Jc,J ( J This permit is hereby issued to the above named Drain Layer who,has a valid
license i. qd►by the Sbw of Cmww W and has on file, safisfactory bond
Premises subject to and insurance in the dame of the Town of south Wind/
lntertown Agreement l J d
Record of Sewer
Assessment "l'H--�. Issued by Date-/ 'f'h 1r
INSPECTION
Date Work Started 7 ,
Comments pate Completed
APPROVED: r
Ins , .-__
P ctor Date
INSPECTION REQUEST
DATE'OF"Rff=ST.: TIME.:
BY:- g &GLf7T FOR LOCATION: /9 G'/jrZ-41a-ov1 j2
DAY INSP.EC. NEEDED. / Z�—/ -�.f TIME:-
TYPE" OF INSPECTION.—.
SANITARY.ZL TERA . PERMIT NO
� } . : :.( , . f. FQOTIBIG: DRAIN
( ) E%CAVATrON" (PERMIT -NO. ) ( ) OTHER
INSPECT,ION," REPORT
DATE.. TIME: %-3G) /G�d� INSP•
CONTRALTO$: WF,AT=.
WORK IN PROGRESS:
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L./iyl= i �°� >%FZ' G/�i'�� .�'� f� i7�f� �i �fZ-' G= •=C c>�. j�v�-�j�
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: