HomeMy WebLinkAboutDrain Layers Permit 21 Shares Lane .Q .3,�...k.. ,` ' .'' 'rr.`AS.
6396
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU,OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: z
Pursuant to written application, permission is;hereby ranted;o�the Licensed Drain Layer named herein to
perform work at ��JA�o 9/., Lot# as indicated bz10 at
premises ovine bd y - whose address isJr
to Lay House Drain'_ ,�Repair Ho se Drain. , Lay Main OtlKerfor
occupancy or use, with " acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE. 'INDUSTRIAL WASTES(1,
OR{J Connecdon will be made with A#
work to be in accordance with Town of South Windsor standards, al/OSHA requirements and the conditions
indicated on the back of this emit.
Proposed start date 7/ WEstimated time for completion / C
Permit is to be issued to the holder of Drain Layer's License No.
C� Only holders of P1 W9 licenses will be issued permit. Permit roil/exvire thirty (M
after,Ze 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 h received Town Str��tion P it No.
andfor ConnDOT Permit No. _
Signed
sensed Drain Layer
FOR TOWN USE ONL Y
Permit Fee Paid$ 7.,4�" (Check No.) f U G
Y N Connection Charge $ 6 00 (Receipt No.) -41h.�J Dated 7--04+���
Insurance on File (0 ( )
Bond on File (9 ( ) This permit is hereby issued to the above mined Drain Layer who has a valid
license issued by the State of Connecticut and has on file,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement ( I (1
Record of Sewer
Assessment ( I ( J Issued by Date Z "ZT9G
INSPECTION
Date Work Started Date CompletedZ-�-3,�
Comments
APPROVED:
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: -7i7 S'� TIME:
BY: LOCATION:
Zti?—l� FOR
DAY INSPEC. NEEDED �=�� 7G TIME:
TYPE OF INSPECTION:
( �) SANITARY/LATERAL (PERMIT NO.4!53�!G } ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. } ( ) OTHER
INSPECTION REPORT
DATE: TIME: ���/ INSP:
CONTRACTORS ��1/IGGe LT�G�62-r/, WEATHER:
WORK IN PROGRESS:
c_
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: