HomeMy WebLinkAboutDrain Layers Permit 165 Rimfield Drive 6374
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to.
perform work at Lot# Z-ef indi ated e% , at
premises owned by whose address is � i and
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.• SANITARY SEWAGE. ,,INDUSTR/AL WASTES O,
OR(1 Connection will be made with. S Z?R "4�j ;4//
work to be in accordance with town of South Windsor standards, a//OSHA requirements and theconditions
indicated on the back of this,permit.`
Proposed'start date Estimated time for completion. [
Permit is to be issued to; U.- $ ho/der.of Dram Layer's License No
Only holders of Pl.. 7 & W9 licenses will b issued permit. Permit wilt expire minty f3o).
days after date-.ot issuance. _''The undersigned Drain Layer hereby agrees to al/ the,terms and conditions let
forth in the permit and the reverse side thereof. Applicant has received Town Street Excavation Permit No.
and/or ConnDOT Permit No.
Signed 7�. G --
L/oens rain er
MR-'TOWN USE QNL-Y', .
a%
Permit Fee Paid$ (Check No.) �
Yf N Connection Charge $ /„DO DC� (Receipt No.J Dated l 7
Insurance on File A ( I
Bond on File (!,Y( I This permit is hereby issued to the above named Drwn'Layer who has a valid
license issued by the State of Connecticut and has on file, sadnUctary bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( 7
Record of Sewer
Assessment ( 1 ( I Issued by Date J
INSPECTION
Date Work Started 2-0 6 Date Completed f Z- tv�ls
Comments
APPROVED: '
/nZ j7i�o(�
Inspector Date
SANITARY.LATERAL& EXCAVATION PERMIT
INSPECTION REQUEST
psi !�l-s.
DATE"OF-.BE ST: —/ TIME:_��p�"✓J
BY: `jt_� 4FOR LOCATION:
J n�
DAY" INSPEC'.- NEEDED: 1 Zl f TIME:
TYPE:".OF .rNSPECTZ0lft-.:
( t--rs?aqITART/LATERA (FERL4Mr,NG 3`1 } ;;E } ;. ..Fool NG_-' IK ,-
EKCAV3LTr0N (PERMIT.-No.
INSP W,,REP0FtT
TIME: INSF: of
CORTREc o f -:�
WORK IN .PROGRESS-...
AREA OF CONCERN:
SPECIAL INSTRiTCT20NS:
$tw.f