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HomeMy WebLinkAboutDrain Layers Permit 96 Rugby Lane r, 6433 TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYTR�S PERMIT DATE: J 40 Pursuant to written plicati n,pe, /ssion is hereby granted to the Licensed Drain Layer named herein to perform work at Lt# Z a i dicated b;`�i .�at premises owned by whose address is !' and to Lay House Drain JC, Repair House Drain , Lay Main Other for occupancy or use, with acres. Type of Spyvage to be connected under this permit., SANITARYSEWAGEA INDUSTRIAL WASTES(), OR f J _ , r.�,. Connection will be made with Ail 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 Estimated time or comp/etlon P Permit is 4P b.e issued to the holder of Drain Layer's License No. 0 Only holders of 1, & W9 licenses will be issued permit. Permit will exvire thirty (30) days after date'of 4XWn g. The un ersignad Drain Layer hereby agrees to all the terms and cond/t/ons set. forth in the permit and the reverse side thereof. App&ant has receiv%d Town Street cavation Permit No. andfor ConnDOT Permit No. _ Signed Licensed Drain Layer, A00 TOWN USE ONLY Permit Fee Paid$ ?-I- (Check No.) Y Connection Charge $ loo, ®© (ReceiptNo.) y/�/6 Dated �' . 96 Insurance on File (✓I( 1 Bond on File 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 Tile,satisfactory bond Premises subject to and insurance in the name of the Town of South Windsor. lntertown Agreement ( l ( I Record of Sewer Assessment ( 1 ( 1 = Issued by .�.�.-`t.. ...�w-+-.,• Date 4" 9d INSPECTION Date Work Started /Z6lT�" Date Completed Comments APPROVED: �n p.cto Dates ILI 10 VIC SAO MI f NIP /WI 0 A + 1 E. Fm wArEff NI X rSTROA • � arb N.7 rp.I !C! XfII X7I•l X 6is.{ XII.! X6 f MI XJI.I l X 1 ✓ X 7d! ?Ire ro. e X7X7 77. It , Aj7f fb CAMER/ME S. CL/ ; O 90 Z �h 1 85 e t 75 1 289.E=9"rYC 00Wo •/.. 70 S 66 ' 30t00 31t00 32t00 33t00 34t00 SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE.`OF REQUEST,: TIME: : BY: .!/ ._ /lr.���s — FOR LOCATION: DAY-.:INSPEC. NEEDED TIME: A-9 , TYPE OF INSPECTION: ` FOOTING-,DRAIN SANITARYlLATERAL _(-PERMIT;;NQ° • 6���.� }, ( ) i ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER t INSPEGM� N ,.-REPORT. DATE: -���o�$� TIME INSP: �—• «���,.��' t . r -CONTRACTOR--:",.-'' WEATHER pe psd�v.�y . WORK IN PROGRESS: loor l�r�.�✓.� �� r �i�r-ram�.5-Ur �/'�d1� ��Gce rG�`-� AREA OF CONCERN:. SPECIAL INSTRUCTIONS: