HomeMy WebLinkAboutDrain Layers Permit 949 Pleasant Valley (2) 6344
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT f
DATE. /
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named:herein to
perform work at y' f� , 9K/A _101f &'Y /�j Lot# as indicated below, at
premises owned by eta- whose address is /2�0,0-i� and
to Lay House Drain , Repair House Drains Lay Main , Other , for
occupancy oouse, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE.jV, INDUSTRIAL WASTES!),
OR(1 Connection will be made with Pk,-4, 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. - / r.� 7—
Proposed start date /p-/6 -g Estimated time for completion
Permit is-to be issued to. 4,ewiu,1 the holder.of Drain Layer's"License Nix
A4I412 . , Only holders of P.1,11P7 W9 icenses will be issued permit. Permit will expire M&M(301
days aher 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 Serezz
ation Permit No.
and/or ConnDOT Permit No.
Signed
Licensed Drain layer
FOR TOWN USE Oft Y
Permit Fee Paid$ (Check No.) Z' ei'i
Y N Connection Charge $ (Receipt No.) Dated
Insurance on File ( 1{ )
Bond on File f 1O This permit is hereby issued to the above named Drwn Layer who has a valid
license issued by the State of Connecticut and has on Ne, satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( ) (1K1
Record of Sewer
Assessment f-i-f— Issued by G Date
INSPECTION
Date Work Started Date Completed'
Comments
APPROVED
Ins -pector Date
SANITARY LATERAL &EXCAVATION PERMIT
INSPECTION.REQUEST
'DATES OF REQUEST: ' ��-/3 `15 TIME: _
BY FOR LOCATION: �y�Otit�o�
DAY`INSPEC. NEEDED �D -'/6Pg4' TIME: /c)7!
TYPE..OF. INSPECTION:
( ) SANTTARVLATERAI, ('PERMZT'NG� FOOTING-DRAI1lI
+ ( ) EXCAVATION (PERMIT NO. ) ( } OTHER
INSPECTIOK;REPORT ..
DATE.: %p /�"` !J TIME: INSP:
# CONTRACTOR -: WEAT- ER':.- G�
WORK .IN PROGRESS
• ���/ wILL G l y� %IGs/.�S vtit!/llL'�i� j V 7'�'�S'�c»��
AREA OF CONCERN:
' SPECIAL INSTRUCTIONS: