HomeMy WebLinkAboutDrain Layers Permit 45 Ridge Road ..4
6435
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT -°136
DATE:: .1
Pursuant to written appli ti n, per ion 's hereby anted t the Licensed Drain Layer named herein to
perform work at /^ tDCp l Lot# as indicated below,.at
premises awned by A C. C.4 whose address is and
to Lay House Drain Repair-11ouse6rain , Lay Main , Other , for
occupancy or use, with acres.
Type of Sewa9e to be connected under this permit.. SANITARY SEWAGE(N;INDUSTRIAL WASTES 11,
off() Connection will be made with f < 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 3 Est' ted time for completion
Permit is to be issued to the holder of Drain Layer's License No.
O 0 olG (, 4iy0 Only holders of P1, P7 & W9 licenses will be issued permit. Permit will exoire 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 aide thereof. Applicant has received Tow tree vatio Permit No.
and✓or ConnDOT Permit No.
Signed
Ucensed Drain Layer
IRU 111 « Q&9CA0QVI0
_. FOR rMN-USE 0AC),
Permit Fee Paid $ of f-o v (Check No.)
Y N Connection Charge $ 7 00.00 (Receipt No.), ,46oP G Dated 5 W 96
Insurance on File M ( 1
Bond on File Mf( J This permit is hereby imued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on file,sattf Wwy bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement ( l f 1
r ( J ( Issued by
INSPECTION
Date Work Started /,z 9 Date Completed
Comments
APPROVED:
Insp ctor Date ,-
` SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 5/3c)I <6 TIME:. /
BY: FOR LOCATION:,
DAY INSPEC. NEEDED 3 0 /c TIME:
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. jr13S ) ( ) FOOTING DRAIN
{ ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP: T ��✓����a-
CONTRACTOR: 3�YG d��--�i� WEATHER: �o • p�/�✓
WORK IN PROGRESS:
��� >i✓V�siLN��'GL.sy Lii��7 S 4 N�<�DC�x sU�rso/G
Ts e-i.✓ �2en/�O� ��s�_ �.y.�►.✓<irs� <.yTB"Q/diZ �G U/s/��
_ _ !� io �/`zc� c....y®�rt� �.r.�i�.s•�-- �a ��e..✓�a� .ado.�sC" _
AREA OF CONCERN: .
SPECIAL INSTRUCTIONS;