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HomeMy WebLinkAboutDrain Layers Permit 23 Shares Lane N ' 6395 'OWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU,OF POLLUTION CONTROL , DRAIN LAYER'S PERMIT 3 DATE: . . Pursuant to written application, ermiswn is here y granted to the Licensed Drain Layer named herein to perform work atf�� �.S�i��,�' ? .5 !�s,�t .0 Lot# as indicated b ow, a .w premises own@6 b whose'address is an to Lay House Drain'*' epair H se Drain , Lay Maier O er .for occupancy or use, with'` acres. I Type of Sewage to be connected Under this permit:_ SANITARY SEW AGE( ,�IJVDUSTRIAL WASTES l 1, OR(J Contraction will be grade with . All work to lie in accordance with Town of South Windsor standards, ail OSHA requirements:and the conditions indicated on the back of this permit.. Proposed start date 2Z Estimated time for completion Penn? i t :be issued to .�'�. �'�` �`' the holder of Drain Layer's License No. Only holders of P1, & W8 licenses 'w/l/lie issued permit. Permit will exa/ra thirty (301 days after date of/ssuanr Tha undersigned.©rain Layer hereby agrees to a//the terms and conditions set forth in the permit and the reverse side thereof. `Applicant ha$.reee/ured To n Ste t, ation it No. and/or ConnDOT Permit No. signed ' - ,.�i Licensed Drain Layer FOR'''OINISI llSF ONLY Permit Fee Paid S 2--4 (Check No.) f/D Y Connection Charge $ G ow `.' (Receipt No.l g'� Dated l Z-o y-9� Insurance on File (� Bond on File f ( This permit is hereby rued to the above named Drain Layer who has a valid l/cense issued by the State of Connecting and has on f7r e,satisfactory bond Premises subject to / and insurance k7 the nand of the Town'of South Windsor. Intertown Agreement Record of Sewer Assessment ( 1 l 1 Issued by / Date INSPECTION Date Work ,Started Z-Z7 Tj;" . Date Completed 2--Z7--15G Comments ` APPROVED: i! lZ y r Z7 Inspector Date SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: Z " ��- g G TIME:- BY: �� /L/l-G�?� l�v/LGp FOR LOCATION:,�,L����'� DAY INSPEC. NEEDED 2'��- l�6 TIME: TYPE OF INSPECTION: ( ) SANITARY/LATERAL (PERMIT NO. G 3 9S i ) ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE: 2' 0,7"9C TIME: 1oYI INSP: i l� CONTRACTOR: G�)4- WEATHER: WORK IN PROGRESS: AREA OF CONCERN: . SPECIAL INSTRUCTIONS: