HomeMy WebLinkAboutDrain Layers Permit 31 Shares Lane 6367
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:. ,
Pursuant to written application, permission is hereby r ted to MaJicensed rain Layer named herein to
perform work atG/r'Tl�"fr' �'r ��„�r' �j / - ',rLot# as indicated be%w,`at
premises ovine by - 6 or�yhose address is 7 7
to Lay House Drain Repair House Orain , Lay Main _ , Othe , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit. SANITARY SEWAGE( , INDUSTR/ L WASTES(l,
OR:f J Connection will be made w/thm' `` Al/
work to be in accordance with Town of South Windsor standards, al/OSHA requireme s and the conditions
indicated on the back of this permit.
Proposed start date Estimated time for completion
61 , Gl /. t��'-S`rh��lc�o�CoDrne�
Permit ' o.be issued to holder of Drain Layer's License No.
Only holders of P7, 7 & W9 licenses will be issued permit. hermit will expire thirty (30)
days after date of issuance. The untTersigned Drain Layer hereby agrees to al/the terms and"conditions set
forth in the permit and the reverse side thereof. Applicant has received Town eet cap on Permit No.
and/or ConnDOT Permit No. .C --
Signed
Licensed Drain Layer
FOR TOWN USE ONLY
Permit Fee Paid$ 2-5 00 (Check No.)
Y A Connection Charge $ -p 0 (Receipt No.) � Dated!Z
Insurance on File
Bond on File ` (vf 1 This permit is hereby issued to the above reamed Drain Layer who has a valid
//dense 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
Record of Sewer
Assessment ( I ( 1 Issued b Date /Z .
INSPECTION
Date Work Started Date Completed 1 Zif0G
Comments
APPROVED:
Inspector Date
SANITARY LA.TERAL.'& EXCAVATION PERMIT
INSPECTION REQUEST"lien
DATE. OF BEQUEST: af
7 TIMB': 4 -
_ .
BY.: l FOR LOCATION= 4�-3/
DAY' INSPEC". N EDED: "121�1i1 TIME:
TYPE--OF -INSPECTION*.;-:-;--
( t,, 5141�ITARFlZBTERAU (PERM='✓: 1�?`: y ,:� ",}_ .•FOOTING 'DRA.
( ) EXCAVATrW (PERMIT.-NQ. } _...:;( .. } OTHER.
T#G
II�SPE i1 AEPOMT�
s 34. r 2 Y
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TIME. /� ! INSP:
,, ��. � � • - �� �p�_�S
Gv�L WEATS£R": � "�''
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r IN PROGRESS r- w W4
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AREA,,Ok' CONCERN a
SPECIAL,` INSTRUCTIONS s ;