HomeMy WebLinkAboutDrain Layers Permit 79 Pierce Road 'Y
NO 6387
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: zg-6'
Pursuant to written application, permission granted to the Licensed Drain Layer named herein to
perform work at -7 9 2,"ec , Lot# as indicated below, at
premises owned by whose address is and
to Lay House Oran Repair House Drain , Lay Main. , Outer , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE , INDUSTRIAL WASTES(J,
OR (J Connection will be made with AI/
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
I indicated on the back of this permit.
Proposed'start date 4 6 Estimated time for completion xl�A a, ,
Permit Is to be issued to a �. the holder of brain Layer's License No.
Only holders of P1 P7& W9 licenses will be issuedpermit. Permit will exoire thirty (30J-
days after date of issuance., The undersigned Drain Layer hereby agrees to a//the terms and conditions set
forth in the=permit and the reverse side thereof. Applicant has received.Town S;L- y
vadon Permit No.
andfor ConnDOT Permit No. ,
Signed
Licensed Drain
FOR TOWN USE ONLY
Permit Fee Paid$ te- (Check No.) -
Y N` Connection Charge $ (Receipt No.) 9 5 Dated y- —4
insurance on File ( ( J
Bond on File This permit is hereby issued to the sW ve nerved Drain Layer who has a,valid
license issued by the State of Connecdi*and has on file,satisfactory bond
! ' Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement F J ( l
Record of Sewer ,
Assessment ( o Issued by - Date
INSPECTION
Date Work Started , -/ —. l® Date Completed
Comments `('1 �� ����c� �v � s�c,�_r � - � Tzfzs3r�✓u�
APPROVED: ,
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:—
BY: � L�6 ,�i1� �vS/f FOR LOCATION:—.,;7
DAY INSPEC . NEEDED C ��� TIME: ��n
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT NO. (ems ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: / 1,9 TIME: INSP: �
CONTRACTOR:- h G%�✓/ �C WEATHER: i 'S
WORK IN PROGRESS :
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: