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HomeMy WebLinkAboutDrain Layers Permit 39 Shares Lane ! 6360 TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT DATE: 1-7 19 f Pursuant to written annIlIcadon, permission is hereby granted to the Licensed Drain Layer named herein to perform work at 7 Lot#IjQ_as indicated below, at premises owned by, r�r whose address is and to Lay House Drain , Re air House Drain , Lay Main ther , for= occupancy or use; with acres. Type of Sewage to be connected under this permit: SANITARY SEWAGE( , INDUSTRIAL W4STE (1, OR () Connection will be made with rr�'`' All work to be in accordance with Town of South Windsor standards, al/OSHA requirements iKd the conditions indicated on the back of this permit. Proposed start date Estimated time for completion Permit is to be issued to the holder of Drain Layer's•License No, Only holders of P1 P7 & W9 licenses will be issued permit. Permit w/ll exoke thirty (301 Mays after date Qf issuance` The undersigned Drain Layer herebyagrees to all the terms and conditions set fo 'i e permit and the reverse aide thereof. Applicant h _ own et cavat/ Permit No. and/or ConnDOT Permit No. � �;..� Signed Licensed rain Layer FOR TOWN USE ONLY Permit Fee Paid $4,5.ou (Check No.) Elan Y N Connection Charge $ Qw.aca (ReceiptNo.J G360 Dated 11-as-4S' Insurance on File Bond on File (✓1'( J This permit is hereby issued to the above named Drain Layer who has a valid license issued by the State of Connacdcut and has on No,satisfactory bond Premises subject to and insurance in the name of the Town of South Windsor. Intertown Agreement ( -I (w Record of Sewer Assessment -&Tr T'� Issued by I,E°' `Z � Date INSPECTION Date Work Started �— .2/�g� Date Completed Comments APPROVED: Inspector Date SANITARY LATERAL.&, EXCAVATION PERMIT INSPECTION 'REQUEST DATE, OF.REQUEST: l' Z/--5 51 TIME-.-: r gy; /L�n 7S• FOR LOCATION:© s DAY INSPEC. NEEDED //�Z/— �J/ TIME: Pal TYPE OF INSPECTION: ;# ( x ) S1�NLTARY T ATERAI' (`�PERNIT, NO= G 3 } FOOT, DRAIN.. ( } EXCAVATIOU.. (PERMIT.NO. ) ( } OTIM I NSPECTIOf*=.REPORT,.,-,. . DATE: .4 /�—?�/- Py� TIME: INSP: s ' CONTRACTOR--, Gli/ x WRATHEER WORD IN •PROGRESS: 'Ov r) AREA OF CONCERN: SPECIAL INSTRUCTIONS: