HomeMy WebLinkAboutDrain Layers Permit 12 Porter Green q F, ;.�e•r:'.aa'/! c i.' ' f�e4" j3 a_ z c rs�° e i i F "' j rr._f.
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TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROI.
DRAIN LAYER'S PERMIT /
DATE:
Pursuant to wr/tt n appl/cati n, perm scion is hereby granted to the Licensed Drain Layer named herein to,
perform work at �� pvf �r �r' Lot# as indicated be/o at
premises owned by J'./M T j2, whose address ' S and
to Lay House Drain , Repair House Drain , Lay Main 4 Other r
occupancy or,use, with yyi acres.
a
Type of Sewage to be connected under this permit.• SANITARY SEWAGE ,INDUSTRIAL WAST S!J,
OR(l Connection will be made with 5"1> A/l
work to be in accordance with Town of South Windsor standards,all OSHA requirements.and the condirions
indicated on the back of this permit.
Proposed start date Estimated time for completion
erm1t is to be issued to Zok^ cS 'T the holder of Drain Layer's License No..
? 8 34 Only holders of P1, P7 & W9 i enses will be issued permit. Permit will expire thirty (3Dl
days after.date of issuance. The undersigned Drain Layer hereby agrees to'all the terms and condkions set
forth in the permit and the reverse side thereof. Applicant ha re ived own Street Excavation Permit No.'
and/or ConnDOT Permit No.
Signed -
ns rain Layer
FOR TOWN USE ONLY
Permit Fee Paid$ 5 d (Check No.)
V N Connection Char e S 600. 00 (Receipt No.) Gqq2 Dated -1
Insurance on File 64 ( )
Bond on File M ( 1 This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of C.onneciicutand has on Ne, 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��S/ 4c
INSPECTION
Date Work Started 6 Date Completed _ylxelr6
Comments
APPROVED:
Ag
Znspe or Date
SANITARY LATERAL & EXCAVATION PERMIT
�1 t
INSPECTION REQUEST
DATE . OF REQUEST: "'A TIME: io.
BY: �.o-✓cy ,Y.�:�.�i-s FOR LOCATION:,.,eZ
DAY INSPEC. NEEDED z� _� TIME:
TYPE OF INSPECTION:
r. .
{ r/) SANITARY/LATERAL (PERMIT NO. 6+O' Z ( ) FOOTING DRAIN
{ ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: �/p TIME: INSP: y: L�r�o-.✓�
CONTRACTOR: WEATHER: �-® •s��,.w�-
WORK IN PROGRESS:
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AREA OF CONCERN: -
SPECIAL INSTRUCTIONS: