HomeMy WebLinkAboutDrain Layers Permit 94 Orchard Hill Driv $ 6317
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S
Pursuant to written an�li atio per is he�trijgr nted to the Licens d ain Layer named herein to
perform work at / �= �J ►- Lot# as indicated below, at
F premises owned by whose address/s � and
to Lay House Drain , Repair House Drain Lay Main , Other , for
` occupancy or use, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE( , INDUSTRIAL WASJi")
1,
OR 0Connecrion wilt be made with Al1
work to be;in accordance with Town of South Windsor standards, al/OSHA requirements and the conditions
indlcatedon the back of this permit.
Proposed start date 95 Estimated time for completion a4. 1/
Perlmit_lq to be issued to wyotrip C. the holder of Drain Layer's License No.
Only holders of P1, P7 J W9 licenses w/l be issued permit. Permit will expire thirty QQ
days after date of issuance. The undersigned Drain Layer hereby agrees to al/ the terms and conditions set
forth in tire}permit and the reverse side thereof. Applicant has received VTowntrvet Excavation Pennit No.
nd/or ConnDOT Permit No.
Signe
R {{� d
�tJ / /J 3 L100 ? 3 Licensed Dram Layer
FOR TOWN USE OM Y
Permit Fee Paid S -CEO (Check No.) 13
Y N Connection Charge $ &.Do•OL� (ReceiptNo.1 s Dated
Insurance on File ( ( 1
Bond on File (✓1 ( J This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecbbut avid has on Me,sadsfactory bond
Premises subject to and insurance in the name of the Towsr of South Windsor.
Intertown Agreement l J (N
Record of Sewer t, ���1
Assessment ( I ( I Issued by Date v�<
(J
INSPECTION
Date Work Started Z S- 9 s Date Completed
Comments
APPROVED:
I Spector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 2- 5 -9-5 TIME: /� "'oe}
BY: SZ FOR LOCATION:
DAY INSPEC. NEEDED G' "�� cj TIME:
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT. NO. ) ( ) FOOTING. DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION- REPORT., ,
DATE: Z c S TIME: O � C) C-) INSP:
ev
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CONTRACTOR WEATHER 7 S
WORK IN PROGRESS: 440 �Lvt-'
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AREA OF CONCERN: ��
SPECIAL INSTRUCTIONS: -