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HomeMy WebLinkAboutDrain Layers Permit 8 Perrin Lane (3) TOWN Of SOUTH WI N DSOR DEPARTMENT OR'PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT '"NO 5791 © 19 Pursuant to written application, permission is hereby granted to the Licensed Dra.i La er lake her Z to perform the work indicated below at hD S t premises owned by 3 .]"' who de address h0'So d to j Lay House. Dra< n, Repair use Drain, - Lay Main, Other , for occupancy or use, with:JAo4% Family Uni s, with acres. Type of Sewage to be connected under this permit : SANITARY SEWAGE (✓) ' INDUSTRIAL WASTES ( ) , OR Connection will be made with n110 Show sketch of proposed work or furnish two (2) copies of separate drawings. SPECIAL CONDITIONS S49 b-e Desired Starting Date v q Estimated Time for. Co letion : Permit to be issue to Z�104 the holder of Drain Layer's License No. P rm t w l expire thirty (30) days after date of issuance. The undersigned Drain La.y r ,hereby agrees to .all the terms and conditions set forth in the permit and, the reverse side thereof,. Applicant has received Town Permit No. and/or. CHD Permit No. Signed o� J L censV Drain Layer The above named Drain Layer has a val d license issued by the State of Connecticut and has filed a satisfa tory. bond and insurance policy in the name ;of the Town of South Windsor Engineering Dept. Date Permit Fee Paid $ �!!� Check Number �����z 4_Z. Connection Charge Receipt No. yf Dated Issued by INSPECTION Date work started Date completed Sufficient notific=ion receives ; yes No Special Conditions APPROVED: Inspector Date BOND TOWN OF SOUTH WINDSOR N° 853 A m Req. PUBLIC WORKS D,ZPARTMENT Date TOV�NHALL on File 1540 SULLIVAN AVENUE Permit No. SOUTH WINDSOR, CT 06074 Date of Expiration Permit Expires APPLICATION. FOR PERMIT FEE Name and address of applicant _J /b? • J h' Phone No, 7 > c: 65 � Location of proposed work /t , Describe fully nature of permit requested Insurance on file with Town ( yes ) no Date policy expires c Name of Insurer IUA i "a,u w O Approximate time for completion Desired starting date Call before you dig ticket Poo. 9 Z Z Show sketch of proposed work or furnish 2 copies of separate drawings a a w o > 0 O U O 41 O td U a QApplicant is responsible for contacting the Police Department and CALL BEFORE YOU DIG. I agree to furnish to the Town of South Windsor the amount of bond or deposit required and to reimburse the Town of South Windsor for any expenses incurred by the Town for maintenance or repair work in connection with this permit and that I am familiar with and will abide by the rules and regulations for permits as outlined in the Town of South Windsor's (Pavement Cut Regulations.) Signed APPROVED: DATE APPROVED: 7 T' DATE Supt. of Highways Town Engineer FOR INSPECTOR: Date work started Date completed Sufficient notification received: yes no Type of repair: Perm. Temp. Unusual conditions encountered Material slips attached: yes no Dated for Permanent repair Signed Inspector