HomeMy WebLinkAboutDrain Layers Permit 41 Shares Lane NO 6361
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 Licensed Drain Layer named herein to
perform work at , Lot# L as indicated below, at
Premises owned b f �4vhose address is �_r"_ At`� Grand
to Lay House Drain Repai ouse Drain , Lay Main th r , for
occupancy or use,' with acres.
Type of Sewage to be connected under this permit. SANITARY SEWAGE l ,INDUSTRIA WASTES(J,
OR(I` Connection will be made with 0V . All
work to be.in accordance with Town of South Windsor standards, al/OSHA requirements atfd the conditions
indicated on.the.back of this permit.
Proposed start date Estimated time for completion
Permit is to be issued to /1✓�/ ct�k. the holder of Drain Layer's License No.
. :.Only holders of P1, P7 & W9 licenses will be issued permit. Permit will exoire th/riv QQJ
days after date of issuance. The undersigned Drain Layer hereby agrees to al/ the terms and conditions set
forth in h ermit and the reverse side thereof. Applicant "Mce/ved wn t Excave n Permit NO.
and/or ConnDOT Permit No.
Signed
Licensed Drain Layer
FOR TOWN USE ONLY .
Permit Fee Paid$ � (Check No.) 42n6r\
Y/N Connection Charge $ GW-o0 (Receipt No.) ��G\ Dated 1 i-c'b-qy
Insurance on File (vl ( 1
Bond on File 447 This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on No, satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ! 1
Record of Sewer r
Assessment J-�7 ' Issued by 1� Date
INSPECTION
t
Date Work Started 7-/40/ Date Completed /I Z/-gam
Comments
APPROVED: /
Inspector Date
1
SANITARY LATERAL &. EXCAVATION PERMIT
INSPECTION REQUEST
DATE':':OF` REQUESTr �/---_7V' q,�, ! T=.-
BY: Gv/uyoy_ l X FOR LOCATION: Pa�2iZYL�i "�,� vr.�%%�
DAY INSPEC. NEEDED TIME:
f` ' TYPE'"OFINSPECTION:
( SANITARY/LATERAL::f.PERNIT�'-Na eo s } .: j' FOOTING::DRALN . , .,
( / ) EXCAVATION. . (PERMIT NO. ) ( j OTHER
INSPECTIOW REPORTY
t DATE; TIME: INSP:
CONTRACTOR .:. -1�JLG�� WEATHER-::
WORK IN,. PROGRESS::
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: