HomeMy WebLinkAboutDrain Layers Permit 27 Shares Lane or,e'T�RnCP1'�1F'.�. ice . ., 'hC" N`: _ ti. .{r. } -r. .. ;.'ai - L,-
N 6369
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S
DATE:
Pursuant to written application,permission is hereby, rante to the Licensed Drain Layer named herein to
perform work,at Lot# as indicated elow,,a.,tt
premises own e y - r ,whose address is r L' aaF
to Lay House Draih r'Repair Hou Drain Lay Main O er , for
occupancy or use, with acres.
Type of Sewage to be connected,under this permit., SANITARY SEWAGE( , INDUSTRIAL WASTES(J,
OR f J Connection will be made with,6'r ,. All
work to be in accordance with Town of South Windsor standards, all OSHA requireme and the'conditions
indicated on the back of this permit.
Proposed start date' Estimated time for completion / /
Permit is to be issued to !/M l / t .S holder of rain license No._
O Only holders:of P 1, 7 W9 licenses will be issued,permit. ; Permit will exvire thirty /30J
days after date of issuance. The un signed Drain Layer hereby agrees to all the terms and condidons set
forth in the permit and the reverse side thereof. Applicant has, resei Town S het Fxca.ya Permit No.
and/or ConnDOT Permit No.
Signed .
ceased Drain Layer
FOR TOWN USE ONL Y
Permit Fee Paid$ "W �S�a(Check No.) /�3
Y/N Connection Charge $ 6eo•yU tReceipt No.J Dated
Insurance on File (C7 ( J
Bond on File (V( J This pennit is hereby issued to the above named Drain.Layer who has a valid
lkense 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 { ) (t�!
Record of Sewer
Assessment ( J ( J Issued by Date fZ"
INSPECTION
Date Work Started /Z ro G l5 Date Completed
Comments
APPROVED: .
Inspector .: Date
SANITARY:LATERAL.& EXCAVATION PERMIT
INSPECTION REQUEST
DATE.OF_'-fMQUUEST TIME;
BY.: FOR LOCAT I ON z-/�dR.✓"" ffJ�.t.l.'�/
DAY" INSPEC'. NEEDED: -4 Z :06 TIME: - 61i1
.TYPE' OF TNSPECTIQ$t,���.:
t } smg
( ) ESCAVATrW 7 (PERMIT-M. ) _.._:. t:. ) OTHER
INSPECTT ION,
DATE:. - Z�p6 - �'S TIME: l/l/I INSP:
CONTRICTOH -;' GttfLG� WEATHER: 'n---
T40RK IN PROGRESS:._
AREA OF CONCERNS
SPECIAL INSTRUCTIONS: