HomeMy WebLinkAboutDrain Layers Permit 15 Porter Green �.` i'�" �r �,m,,,.x:ti.r..-r:,. -r.., -s.-s:., v,•�:.��. z� 1;3i'�r'>,€'".ri*�r','t�. � `�-- ne.;:u-'r "' .. " - t
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6373
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
-DATE:
Pursuant to written application, ermission is hereby granted to the Licensed Drain Layer named herein to
perform work at S` , Lot#_2L as indicated beloWlat
premises owned by...1 whose address is 6 S
to Lay House Drain Repair House Drain Lay Main , Other r
occupancy or use, with acres.
Type of Sewage to be,connected under this permit.• sAN1TARY SEWAGE 1NDuST /AL WASTES
OR J Connection will be made. '`S Dlh 3 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 me for completion L
Permit is to be issued to the holder of Drain Layer's License No.
�. Only holders of P1, P7 & W9 license ;will be issued permit. Permit 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 Street Excavation Permit No.
and/or ConnDOTPermit No.
Signed
Licen Orai yer
FOR TOWN USE OM Y
Permit Fee Paid$ Zs'-00 (Check No.) .147
YJN Connection Charge $400-0C) (Receipt No.J /:;7 3 Dated /Z
Insurance on File f vJ ( I
Bond on File (vf( 1 This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the Stage of Connecticut a rW has on file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement ( J
Record of Sewer
Assessment ( I ( I issued by Date f
INSPECTION
Date Work Started Date Completed
Comments
APPROVED: .
9�6
Inspector Date
SANITARY LATERAL,_& EXCAVATION PERMIT
INSPECTION REQUEST = 7 .
DATE.'OF'.REIIEST /� - g w TIME.:
BY-: FOR LOCATION: h /� �''ro/P.t^
DAY' INSPEC-.• NEEDID: �lG'' al(o TIME:
TYPE- O£ ,INSPECTZO$:;;.
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( EXCAVATIDW (PERMIT-*MG. 1 .... �.. .. _a OTSEIt
INSPECTIGWREPOF
TIME: INSP: if_n3r
CONTRACObt 't ✓ WE�iTHEff: CiG 7 '
WORK IN', PROGRESS.-. l�� /�S%/j'� -Z!�/� w/!�S /� �r,�
AREA OF CONCERN
SPECIAL INSTRUCTIONS: