HomeMy WebLinkAboutDrain Layers Permit 499 Rye Street 6388
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU:OF POLLUTION CONTROL
DRAIN LAYER'S PERMTI'
DATE:
Pursuant to written a P. radon, permission is hereby granted to the Ucensed Drain Layer named herein to
perform w ork at
S , Lot# as indicated below, at
premises owned by i A v whose address it / (/J .S c aAYT.,, AJ,_4oGGa 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 !J C Al/
permit.• SAN/TARy EWAGE
OR 0 /NDUSTR/AL WASTES<l,
de /�
work to be/n accordance with Town of South Windsor s Connection MY be ma with �' ''standards, a//OSHA requirements and the conditions
indicated on the back of this permit.
Proposed start date c16 Estimated dme for comp/edon,
P'7 Permit is to be issued to vv holder of Drain Layer's License No._
) Only ho/ders;of P1, P7 & W9 �cenI will be issued permit. Permit will expire thirty (30)
days after date of issuance The undersigned Drain Layer hereby agrees to al/the terms and conditions set
forth in the permit and the reverse side thereof. Applicant has received T eet Excavation Permit No.
�s2 and/or ConnDOT Permit No. ---
Signed
Licensed Or .
FOR TOWN USE Oft Y
Permit Fee Paid$ fve G (Check Nod f
Y N Connection Charge $ ..... (Receipt No.) (o 3 a8 Dated - �
Insurance on File ( )
Bond on File 1XI O This permit is hereby issued to the above named Drain Layer who has a valid
li mse issued by the State of Connecdcut and has on Me,satisfactory bond
Premises subject to and insurance in the name of the Town of South Mindsor.
/ntertown Agreement O
v
Record of Sewer �AIN)`a
Assessment % Issued by � t �' Date Z—U
INSPECTION
Date Work Started _ -Zz_51r, Date Completed
Comments
APPROVED:
/ � z�z3v �
Inspector Date
.,. „ .rama• ■ ■r-a■a ■ y.1a GR/yL. a I IV,\
INSPECTION REQUEST
DATE OF REQUEST: TIME: ��
BY: FOR LOCATION:,
DAY INSPEC. NEEDED �v/� Z-ZZ 'IME: 3a
TYPE OF INSPECTION:
O SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: Z-3 '9 TIME: Al-� INSP: Ap"
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
- l� G��r.,r/G:�-i-io-�✓
AREA OF CONCERN: .
SPECIAL INSTRUCTIONS: