HomeMy WebLinkAboutDrain Layers Permit 109 Scantic Meadow R 9 6_ 55
TOWN OF SOUTH WTNDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: , 1
Pursuant to written applicat' n, pe fission s herebygran ed to the Licensed Drain Layer named herein#o
perform work at Lot# as indicated below, at
premises owned by whose address is �/�--1' and
to Lay House Drain Repaj House Drain , Lay Main , Other for
occupancy or use, with / acres.
Type of Sewage to be connected under this permit: SANITARY SEWAGEI), INDUSTRIAL WASTE I,
OR () Connecdon will be made with sAfl
work to be in accordance with Town of South Windsor standards, a//OSHA requirements and the conditi ns
indicated on the back of this permit.
Proposed start date Z1��s r�v Estimated time for comp/erion C .
,
Permi is o be issued to "t'I the ho/der of Drain Layer's License No.
2C �, _.
Only holders of P1, P7 & W9 /tenses will be issued permit.. Permit will exafre thirty (301
days after date of issuance. The undersigned Drain Layer hereby agrees to a//the terms and.conditions set
{ forth in the permit and the reverse side thereof. Applicant has received Town treat Exca anon Permit No.
and/or ConnDOT Permit No.
Signed
(f/3Y"'���✓✓✓ / 9 Licensed Drain Layer
FOR TOWN USE ONLY
aPermit Fee Paid $ a5• o v (Check No.) e6171
Y/N Connection Charge $ 5;3 (Receipt No) 600,00 Dated Ic-ef-45
Insurance on File ('/ ( 1
Bond on File X( I 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 No,se sh wtory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( 1 (?
Record of Sewer
Assessment )-f-1 Issued by Date
INSPECTION
Date Work Started //� P/-� / Date Completed
Comments
APPROVED:
ll✓� i �
Inspector Date
SANITARY-LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST-i 16 131 I q 5 TIME_: 16
BY: �kry\ �YO`�'� FOR LOCATION: �d `i ►1�tc ��
DAY INSPEC. NEEDED I Vw TIME: `00 jAn'\
i TYPE -OF INSPECTION:
{ L/j SANITARY/7jATERAL (`PEFtIKIT Ntx`:b '575 ) ( . . } _ FOOTING DRAIN.
( } EXCAVATION ''(PERMIT NO }, ( } OTHER
- INSPfCTIOU REPORT
. t DATE:. TIME: NSP:
CONTRACTo1 ': j/�/��� AEATER r G�v,3
WORK-. IN PROGRESS: �jLG��I� tom/ �j�2. %�/�'�/7 all
AREA OF CONCERN:
: SPECIAL INSTRUCTIONS: