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HomeMy WebLinkAboutDrain Layers Permit 74 Pine Tree Lane TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT / R 6282 19 ,$ Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to perform the work indicated bqlow at at premises owned .by t/'41 whose', .address i ',-�' - and to Lay House Drain, Repair House Drain, Lay Main, Other for occupancy or use, withF Family Units , with ,acres . Type of Sewage to be connected rode his permi�j SANITARY SEWAGE ) , INDUSTRIAL WASTES ( ) , OR ( ) r * K�, C, SIB /C Connection will be made with Show sketch of proposed work or furnish two (2) copies of separate drawings . OSHA REQUIREMENTS .MUST BE FOLLOWED _ SPECIAL CONDITIONS Desired Starting Date Es-timated Time for Completion / , Permit to be issued tof- the holder of Drain Layer ' s License, No. p Permit will expire thirty (150) 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 has received Town Permit No . and/or C�D Permit No . ' Signed -; � Licensed Dra n Layer The above named Drain Layer has a valid license issued by the State of Connecticut and . has filed a satisfactory b nd and insurance policy in the name of the Town of South Windsor: Engineering Dep Date j ermit Fee Paid $ / D - (2 2 5 - D 0 Check Number onnection Charge Receipt No . Dated Issued by �Z_Y !g -ZA2-� NSPECTION ate work started 7-,� ate completed ufficient notifica onJrece ve es No pecial Conditions APPROVED: I "�r9S nspector Date SANITARY LATERAL & EXCAVATI C-- m pq PERMIT INSPECTION REQUEST DATE OF REQUEST: �' TIME: r n 0. BY: 4 �C�xai' OR LOCATION le r-- DAY INSPEC . NEEDED TIME: r 0 TYP{�E/ OF INSPECTION: ( ) SANITARY/LATERAL (PERMIT NO. 8 } FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) � OTHER // INSPECTION REPORT DATE: (p _// TIME: ' © Q 2Ngp CONTRACTOR: C'�. WEATHER: 1/17 0 WORK IN PROGRESS : e� Z:Q'C t �'1 AREA OF CONCERN: SPECIAL INSTRUCTIONS: