HomeMy WebLinkAboutDrain Layers Permit 231 Scott Drive . »,r-119f y `rT,4r---,.,1 110 71j5 ; x
6325
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to
perform work at ciz3t .Sco?T �PjL , Lot# as indicated below, at
premises owned by -/&A Aqec1r4e2T& whose address is .93/ sc oe- l t- and
to Lay House Drain _, Repair House Drain , Lay Main , Other , for slMik C 69,*/4-
occupancy or use, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE.,,, INDUSTRIAL WASTES(J,
OR(J Connection will be made with (9"PvC Silt I t'All
F work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
ind/cated on the back of this permit.
Proposed start date '� /9 Lf f Eat m ted time for comp/ don `? Z o 9 S-
dk s' sePric fIF
Permit is to be issued to -rfhh Gv L eE the holder of Drain Layer's License No. _
?o 77.4 Only holders of P 1, P7 & W9 licenses will be issued permit. hermit will ex re dirty QQJ
days after date of issuance. The undersigned-Drain Layer hereby agrees all a ter and cond/t/ons set
forth in the permit and the reverse side thereof. Applicant has received Street cave ermit No.
and/or ConnDOT Permit No.
Signed
• ensed Drain fayer
FOR TOWN USE ONLY
Permit Fee Paid$ e3 00 _(Check No.) K�
Y b Connection Charge $ U.U (Receipt No.) DatedQ-1AQT
Insurance on File
Bond on File XJ ( 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,satisfy wry bond
Premises subject to and insurance in the name of the Town of South Windsor..
Intertown Agreement ( J1
Record of Sewer
Assessment ( J ( J Issued by Date
INSPECTION
Date Work Started 9a fe- 9 g Date Completed
Comments
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: -5- TIME:
BY: FOR LOCATION: Z 3� e4.
DAY INSPEC . NEEDED 5 /00 TIME: /12 ,' d O J n
TYPE OF INSPECTION:
( ,k ) SANITARY/LATERAL (PERMIT NO. Z ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: - /� 25 TIME: /D,oO , -2 ; ®y INSP: �
CONTRACTOR:- 4--a-/,�-4r�WEATHER: 7 S ' t
WORK IN PROGRESS: °
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: