HomeMy WebLinkAboutDrain Layers Permit 52 Rugby Lane±�_. ryr,�. . -.,.-',—e-v--•,x4+sroR°a� ;. � ."� .. ;, saw, -. .. r1.:sRz r.i.;� :y.rr-t, �:: r
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602
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: ,�► Z -
Pursuant to M e a ication, permission y grants a Licensed Dr ��' Layer named herein to
perform work at 1 L t#Aqgndlcatet ow, at
premises owned by _ and
to Lay House Drain , Repair House Drain , Lay Main , Other for
occupancy or use, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE.A, INDUSTRIAL WASTES 0,
OR O Connection will be.nfade wtl/ All
work to be in accordance with Town of South Windsor standards,all OSHA requirements and'the conditions
indicated on the back of this
,,peermit.
�
Proposed start date Estimated time for completion
J
Permit is to be issued to �".Oe holder of Drain Layer's License No.
b� . Only holders of P 1 P7 & W9 licenses 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 perok and the reverse side thereof. Applicant has received Town Street Excavation Permit No.
�4 and/or ConnDOT Permit No. r .
ef Signed
Licensed Drain Layer
-FOR-TOWN USE ONLY
Permit Fee Paid.$ S'yo (Check No.) io s.z _
Y N Connection Charge S tip_ ®O (Receipt No.)��,/l3�' Dated ' 2
Insurance on File
Bond on File („y'( J This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on file, satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( J (✓
Record of Sewer
Assessment ( i( J Issued b � DateAA
" PECTION
Date Work Started 7/z Date Completed 7 $�y6
Comments
APPROVED l /
Inspector Date
�} SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST:
� TIME: p� �
_
BY: ♦ FOR LOCATION: �
rc+�U�n�
DAY INSPEC. NEEDED 7/C;Z- TIME:
TYPE OF INSPECTION°
( ) SANITARY/LATERAL PERMIT NO. 6Ys-2- ) { ) FOOTING DRAIN
( ) EXCAVATION (PERMIT :NO v � � ( ) OTHER
INSPECTION REPORT
DATE: �'�Z! �G TIME: INSP:
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
�o-ya - /o �• sus' s`.�.es� - �.�.� �.v�.�®� cc�y
AREA .OF CONCERN: .
SPECIAL INSTRUCTIONS: