HomeMy WebLinkAboutDrain Layers Permit 800 Pleasant Valley ^57_'""ev
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6414
TOWN OF SOUTH WINDSOIt
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT /
DATE: l / 9
Pursuant to written applicati n, permiss'on i re y granted to the Licensed Drain Layer named herein to
perform work at d .d Lot# as indicated below, at
premises owned by --1whose address is 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 0, INDUSTRIAL WASTES(J,
OR(J onnecrio wi 'be made with 4, ' C A#
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 Estimated time for completion
Permit is to be issued to the holder of Drain Layer's License No.
G� GVYX7 Only holders of P1, P7 & W9 licenses will be issued permit., hermit will expire thirty (30)
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 StreQtx va ' n P emit No.
and/or ConnDOT Permit No. l� �r
Signed '
Licensed Wain Layer
FOR TOWN USE ONL Y
Permit Fee Paid S a_5.UO (Check No.)
Y N Connection Charge S GOo•oy (ReceiptNo.) 61"l Dated -{-1�r-V6
Insurance on File (✓J/( J
Bond on File I`/J O This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( J
Record of Sewer
Assessment ( 1 ( J Issued by
INSPECTION
Date Work Started �zZ �` Date Completed
Comments
APPROVED
�ns �tor Day e
r
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: ! l TIME:-
-:: BY: �� \y� '��l FOR LOCATION: Soo . 1p
DAY INSPEC. NEEDED,(��on � TIME:
TYPE OF INSPECTION:
f ( j SANITARYfLATERAL:`(PERNIT-:.NG-, ( j' (, j.. FQOT.ING::.DRAIN,:
+ ( j EXCAVATION (PERMIT NO. j ( j OTHER
+
INSPSCT70U.,REPORT.,,'.,,
DATE: TIME: INSP:
t ; CONTRFiCQR: WEATHER:"
WORK -IN PROGRESS
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: