HomeMy WebLinkAboutDrain Layers Permit 33 Shares Lane '� �T��y<`�f'a+T-Z;i 'M. 51L+�'i+r�'� ��� -aY+ey,•'*-
Ilk, " 6357
TOWN OF SOUTH WINDSO '
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTJgD�gONTROL
1C DRAIN LAYER'S PERMIT
. ,>
E
` Pursuant to written a /icat" n, permissiyn is hereby granted to the Liven ed Drain Layer named herein to
perform work at ! Lot# ' as indicated below, at
premises owned by .-� -� . t,�IrWhose address is
to Lay House Drain Repair Wuse Drain , Lay Main , for
occupancy or use, wit '' acres.
Type of Sewage to be.conni Ct4d`rn'Ar this permit.• SANITARY SEWAGE. 1I7, INDUSTR/A L WASTES(1,
OR() Connection will be made with VC All
work to be in accordance with Town of South Windsor standards, all OSHA requiremen and Oe on� ,
f
.:indicated on the back of this permi#. .Ff,� �� .-f.:;,,1 , :��..r •=�--- /
Proposed start date Estimated time for completions ys
ELF wi
Permit is to be issued to' GU/LOO the holder of Drain Layer's License No.
Only holders.,of P1, P7 & W9 licenses will be issued permit. Perm/t will exa/re thirty f301;
days after dateW issuance.``The undersigned Drain Layer hereby agrees to all the terms and conditions set
forth ' the permit and the revers#~--de thereof. Applicant has race' own Stye t cav on Pe. NO.
and/or ConnDOT Permit No.
Signed
ensed Drain Layer
FOR TOWN USE ONLY
Permit Fee Paid S ri dU (Check No.l AO
Y N Connection Charge $ Coo•CYU (ftece/pt No.1 DatedJ/c`2�•45
Insurance on File
Bond on File (v!( J This permit is hereby issued to the above nakred Drain Layer who has a valid
license issued by the State of Connecticut and has on file,satisfactoryybond
Premises subject to / and insurance in the name of the Town of South Windsor.
lntertown Agreement O (✓1
Record.of Sewer
Assessment Issued by ,,. Data
INSPECTION err
Date Work Started I A f '7'y Date Completed 7--X—
Comments
APPROVED:
r: Inspector Date
�r
SANITARY.LATERAL..& EXCAVATION PERMIT
., INSPECTION. REQUEST. _
DAT'E,'OF'. IIESTZ TIMR:
BY:: Cf�JL X FOR LOCATION: A011 j�=/Z
DAY-• INSPEC NEEDED:f/� ZZ, �f 5 TIME:
.TYPZ -OF INSPECZ20$ , c ,
SAIITAAFtr: etar: (FIItMZT 1�tT �?�
} f', r : )% F00`L`INCr-'TRAII� �
( j EXCAVATIQR .;;. (.PERMIT."NQ. ) .....:(.. OTHER
INSPECTIGWREPOftT. ...:,
TIME: /22 . INSP:
CON TR ACTomr-:
WORK IN':PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: