HomeMy WebLinkAboutDrain Layers Permit 25 Shares Lane771
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6394
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU.OF POLLUTION CONTROL
Z DRAIN LAYER'S. PERMIT
DATE:
Pursuant to written application, permission Is Iterey r #ed to,the ceased Drain Layer named Therein to
perform work at rf !?' S',/ �/�, 3�-�S , A'�C f�!Xtt# as indicated b / w, at
premises ovine by -mots i whose address Is Gs�Hr"' ls� c�ano
to Lay House Drain 1t I/ Repair Ho se Drain , Lay Main -6tfier , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE ; INDUSTRIAL WASTES 0,
OR f l Connection MY be,made with All
work to be in accordance with Town of South Windsor standards, a//OSNA requirements and the conditions
indicated on the back of this permit.
Proposed start date Estimated time for comp/edon. 2
C�r. 4.SrCri �i� .l
Per / i to be issued tobl /�/�f " l.�-!/ � tffe rho�af'e�of Drain Layer's License Na
d ' Only holders of P1 P7 & W9 licenses will be issued permit. Permit will expire thirty(30);
days after date of 4Wjn. The undersigned Drain Layer hereby agrees.to a//the terms and cond/t/ons set
forth /n the permit and the reverse side thereof. Applicant h vela wn ca on Permit No.
and/or ConnDOT Permit No.
Signed
Licensed Drain Layer
FOR TOWN USE ONLY
Permit Fee Paid$ 7,6 (Check No.). /OG
Y N Connection Charge $ G (Receipt No.) 6 5"9'l Dated/Z
Insurance on File
Bond on File 4( 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, satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( I (
Record of Sewer
Assessment ( 1 ( l Issued by Date
INSPECTION
Date Work Started 7- z7- pG Date Completed
Comments
APPROVED:
2-. 94;
Inspector Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:
BY:�� 2/-2-- GCi/L-Ga FOR LOCATION:, a G7'Z- .t/e1fil�-
DAY INSPEC. NEEDED TIME: ,o�-
TYPE OF INSPECTION:
O SANITARY/LATERAL (PERMIT NO. FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: Z 2-7 "`w TIME: /aw7 INSP:
CONTRACTOR:— L=K C-^W, WEATHER:
WORK IN PROGRESS: ! Gv/•�-S �, ��/ L-//yG-�, /Zth�j�
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: