HomeMy WebLinkAboutDrain Layers Permit 33 Sele Drive NO 6397
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 namedherein to
perform work at J Sftg D,Q/r Lot# Z as indicated below,at
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premises owned by AZT0 K. whose address is �T0W P-/./ and
to Lay House Drain Repair House Drain: , Lay Main , Other' , for
occupancy or use, with acres.
Type of Sewage.. to bb connected under this permit. SANITARY SEWAGE,, INDUSTRIAL WASTES!1,
OR{) Connection Sri//be made with `6`f'/'G All
f work to be in accordance with Town of South Windsor standards, a//OSHA requirements and the conditions
indicated on the back of this permit.'
Proposed start date Estimated time for completion
Permit is to be issued t4 SCFrI2 the holder of Drain Layer's License No..
7072i�/ Only holders of P1, P7 & WS licen7es A be'issued permit. Permit will,exoire thirty (30).
days after datc�Qf Issuance. The undersigned Draina r h eby agrees to a//the terms and conditions set
forth permit and the reverse side thereof. App/ic nt h received Town eet vadon Permit No.
and/or ConnDOT Permit No. ot
.Signed
' LlcensedDrain Layer
FOR TOWN USE ONLY
Permit Fee Raid$ (Check No.J v�7d
Y N Connection Charge $ Ga UD•DU(Receipt No.) D Dated 3
Insurance on Me (. 1
Bond on File ( .1 I This permit is hereby ftued to the above named Drain Layer who has a m d
/fronse issued by the State of Conner t and has on File,satfsfactuty,bond
Premises subject to and insunce in the note of the Town of South Windsor.
Intertown Agreement4/7
Record of Sewer
Assessment ( 1 ( 1 Issued .y Date.3h I
INSPECTION
Date Mork Started Date Completed —Zo
Comments
APPROVED:
43
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
ko
INSPECTION REQUEST
400
DATE OF REQUEST: 3=,ph TIME: 3 pAV?
BY: FOR LOCATION: 33 D01445-
DAY INSPEC. NEEDED�ZD/(p TIME: ST A.)( IA_)
TYPE OF INSPECTION:( SANITARY/LATERAL (PERMIT NO.631 7 ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
. DATE: j - Zv' qG TIME: INSP:
CONTRACTOR: C/ /� S<,/,�r-Z-�� WEATHER: /lam/LL=
WORK IN PROGRESS:
T/�Z
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: