HomeMy WebLinkAboutDrain Layers Permit 16 Podunk Circle t
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6320
TOWN OF SOUTH WINDSOR l
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to wri en application, permissions hereby granted to the Licensed Drain Layer named herein to
perform work at /t/ ot#� as indicated below, at
premises owned by whose address is Y X13 50.41162ak c and
to Lay House Drain_X, Repair House Drain Lay Main , Other for
occupancy or use, with acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGE INDUSTRIAL WASTES
OR(J Connection will be made with b'�PVC. . `All
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 1G Estimated time for completion Z�
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Permit is.to be.issued to the holder of Drain Layers License No.
.Q2- Only holders of P1 P7 & W9 licensbs will be issued.permit. Permit will exaire thirty (30i
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 Tow Street Excavation Permit No.
and/or ConnDOT Permit No.
Signed_
Licensed rain Layer
FOR TOWN USE ONLY
Permit Fee Paid$ a 5.00 (check No.l QQzh
Y N Connection Charge S Gc o.o0 (Receipt No.) S7a Dated
Insurance on File t)(1 ( 1
Bond on File (✓1( J 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
Record.of Sewer
Assessment ( 1 ( 1 Issued by Date /
INSPECTION
Date Work Started 2 f - 5 Date Completed
Comments
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
r�
INSPECTION REQUEST
DATE OF REQUEST: - 2-0 S TIME: 3 , (S
oll
BY: - -��� FOR LOCATION: C—Ai
DAY INSPEC. NEEDED - 2- TIME: 9 ;O O
TYPE OF INSPECTION:
( ) SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 9 - 2 / -9 5 TIME: 1 ; 3 o INSP:
CONTRACTOR: Qf WEATHER: C 26
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: