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HomeMy WebLinkAboutDrain Layers Permit 31 Rugby Lane .-.�,,;,.,;•+.�qT_�-„+ere!'r+vArra�.�; ,E°°�"'�7'�:a:=gr :�4� '�P s'"r n'• '."�u"AZ-a�'�'�"�'T y ,: . . �, # ` 64 13 TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT DATE: "/8— w Pursuant to w rtf p Iic ti permission ' hereby r ted to the Licensed Drain Layer named herein to perform work at Lot# as rated be1X premises owned by whose address s and to Lay House Drain Repair House Drain , Lay Main , Other-SA"for occupancy or use, with acres. Type of Sewage to be connected under this perm/t.• SANITARY SEWAGE . INDUSTRIAL WASTES(1, OR O Connection will be made with Ail work to be in accordance with Town of South Windsor standards,all OSHA requirements,andthe conditions indicated on the back of this permit. Proposed start date l 9'4 Estimated time for completion V _ f Gd/t.CO E�cC Rev Per it ' to be issued to ' U the holder of Drain Layer's License No. Oniy holders of P 1Xersigned- & 9 licenses will be issued permit. Permit will expire thirty- (30)` days after date of issuance. The uDrain Layer hereby agrees to al/the terms and conditions set forth in the permit and the reverse side thereof. Applicant has received Town Street 9xvviRtion Permit No. and/or ConnDOT Permit No. Signs• r Licensed Drain Layer FOR TOWN USE ONLY Permit Fee Paid $ Z5,00 (Check No.) C.0 Y N Connection Charge S pG ©0 (Receipt No.) Dated Insurance on File V( ) Bond on File This permit is hereby issued to the above named©rain 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 Record of Sewer Assessment O ( 1 Issued by Date 'Q� INSPECTION Date Work Started 9 Date Completed Comments -- , ' APPROVED: Date Inspecr ..:» � . SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: - TIME: BY: FOR LOCATION: DAY INSPEC. NEEDED -/l M76 TIME: TYP.E .OF 'INSPECTION: ( SANITARY/LATER L -(PMUC `NO.- 644-3 ) ( ): FOOTING:..DR.AIN_..: '( } EXCAVATION (PERMIT NO. ) ( ) OTHER NNSPECGTl0N4.:I-EP0RT :. DATE: K! / 0 TIME: IN TIME: CONTRACTOHi.: I� WEATHERS: WORK IN PROGRESS ;�4 r AREA OF CONCERN: SPECIAL INSTRUCTIONS: