HomeMy WebLinkAboutDrain Layers Permit 35 Shares Lane 6358
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �--
DATE:_�
Pursuant to written application permission is hereby granted to the Licens d 'rain Layer named herein to
perform work at I Lot# as indicated e!o ,.at
Premises owned bye ' E�, i+ r 4 hose address is �, -<<fi�y?' W /hand
to Lay House Drain , Repair kguse Drain , Lay Main the for
occupancy or use, with acres.
Type of Sewage to be connected under this permit. SANITARY SEWAGE /NDUSTRIA P WASTES(J,
OR(J Connection will be made with C�'. Al/
work to be in accordance with Town of South Windsor standards,all OSHA requiremen d.the conditions
indicated on.the back of this permit.
Proposed start date h'_3Estimated time for completion
Permit is to be issued to m f/ ;ol:: 1l cc —Q the holder of Drain Layer's License No
Only holders of P1, P7 & WY licenses will be issued permit. . Plermit will exvire thirty f DJ
days after date.of issuance. The undersigned Drain Layer hereby agrees to all the terms and conditions set
forth in the permit and the reverse side thereof. Applicant has received Town Street Excavation Permit No.-
22
, 'and/or ConnD0T Permit No.
Signed
Licensed Drain Layer
FOR TOWN USE Oft Y
Permit Fee Paid$ AS. oU (Check No.)
Y N Connection Charge $ CQy.00 (Receipt No.) Dated I/ Q-q,
Insurance on File
Bond on File This permit is hey issued to the above named Drain Layer who has a valid
I/cense issued by the State of Connecticut and has on Me,satisfactory bond
Premises subject to f and insurance in the name of the Town of South Windsor.
Intertown Agreement ( I 1VI
Record of Sewer
Assessment ( J ( J Issued by Date
INSPECTION
Date Work Started Date Completed
Comments
APPROVED:
Inspector Date
SANITARY LA,TERAL,.& EXCAVATION PERMIT
INSPECTION REQUEST s
DATE,-OF-.ff =ST
BY: FOR LOCATI ON s
DAY" INSPEC'.' NEEDED 7Z, �S� TIME
TYPE.-0£ -I SPECTZOSt.1.
- ( X } .S�ITAItY�a�rar: .�PERMZT"'1'�Q":- �.�v�J s.;� .�e""',1�, � � FOOT`ING-:�'DRAIl�; •�.�t� . .
_
( EXCAVATI-OW (PERMIT.-NG. ) _....::�.. . , OTHER
DATES. ' - �9 TIME: INSP:
CONTRACTOR aT � =cam k W$A�'HER:� -o GG
WORK IN _PROGRESS:.
• i,Clb ��a1�G-6%�i�
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: