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HomeMy WebLinkAboutDrain Layers Permit 6 Porter Green ' r r 6393 TOWN OF SOUTH WINDSOR DEPARTMENT' OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERIIIT / DATE: Pursuant to written a lice ion, permission 4 hereby granted to the Licensed Drain Layer named herein to perform work,at # Mee Lot JF as indicated below,at premises owned by 77 i! whose address is and to Lay House Drain pair House Brain: Lay Main' Other or occupancy or use, with f acres: Type of Sewage to be connected under this permit: SANITARY SEWAGE 7h, /NDUSTRIAL WASTES(1 s 09101 Connecuon'will be made with .5P9 3 �Afi ` work to be in accardanee'with`Town of South Windsor, tandards, all OSHA requirements and the conditions indicated on the.back of this permit. Proposed start date -2,�=' Estimated time for completion .I Permit/ to be issued to h : G s 1 -60 - the holder of Drain Layer's license No.. 2 3c duly holders.of P1, P7 & W9 /io ses will be issued permit. Permit:will.exoire tfiirty 1301 days after date of/stance. The unders/gned Ora/n Layer hereby agrees to all Me.terms and conditions set forth in the permit and the reverse side thereof. Applicant has received Town Street Excavedon Permit No. and/or ConnDOT Permit No. Signed �LIA Li sed rain.Layer FOR TOWN USE OK Y Permit Fee Paid$ c25 y ICheck No.) o I Yl-N Connection Charge $ Gov. 0o (Receiptfibd G353 Dated 2 -2E-�tC. Insurance on File (✓i ( 1 Bond on File M ( 1 This pem*is hereby issued to.the above named Drain Layer who has a valid license ftwd by the State of ConnaaftW and has on.Me, satisfactory bond Premises subject to and insurance in Lhe name of the Town of South Windsor. lntertown Agreement ( 1 ( Record of Sewer Assessment ( 1 ( 1 Issued by Date INSPECTION Date work Started ©j /y Date Completed Comments APPROVED: 4" 9 Inspec or . Date SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: TIME: BY: FOR LOCATION: DAY INSPEC. NEEDED TIME: TYPE OF INSPECTIO14: ( x ) SANITARY/LATERAL (PERMIT NO. 6.39,E ) ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE: v, ��/ 9L TIME: /o-.Va INSP: CONTRACTOR:-. , WEATHER: SZ-r" s�'��✓y' WORK IN PROGRESS: �.Qo�✓1�vr//�rB"� .tT.�GTSB"� ��'�a.2���"J /�y� h��Y�i� x1.r/�s`e/L ��1>G' �'GG�i�id .�lo®.0 yX� .,rJ� 6 D'•�J7� �� �iP�' G-s��.�v.���-D .��'��72�.!L �s .t�6L cL eq.�� �i�d✓�r TO ��' AREA OF CONCERN: SPECIAL INSTRUCTIONS: