HomeMy WebLinkAboutDrain Layers Permit 45 Shares Lane 6333
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
L/ DATE:
Pursuant to written appli ati 7n, per mission is hereby granted to the Licensed Drain Layer named herein to
perform work at Z526 Y /C Lot# as indicated below, t r�� d.
premises ownedrby _ 1 --�i-irhose address is �' =a <� K� a k s14,1
to Lay House Drain , Repair Hou Drain Lay Main , Oath r , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit., SANITARY SEWAGE , INDUSTR/ ASTES(J,
OR O Connection will be made with r v' Al/
work to be in accordance with Town of South Windsor standards, all OSHA requirements d the conditions
indicated on the back of this permit.
Proposed start date /�'� iy � Estimated time for comp/edon
e 't to be issued to .. '&/!l ,' -5'1-�'the holder of Drain Layer's License No.
O Only holders of P1, EP& W9 licenses will be issued permit. hermit will expire thirty(301
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 own Str et Excav ion P /t No.
and/or ConnDOT Permit No
Signed
Licensed Drain Layer
FOR TOWN USE ONLY 1
Permit Fee Paid$ 57,00 (Check No.i 2
Y N Connection Charge $ dFyo.da (Receipt No.) 4577 Dated 2-/1--
Insurance on File %') ( 1 .494 Al l9
Bond on File ( 1 This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the Stage of Connew*ut and has on No, satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement ( I
Record.of Sewer
Assessment Il ( l Issued by r AzileaDate -f
f
INSPECTION `
Date Work Started g - 5 - q Date Completed
Comments
APPROVED:
spector Date
N.
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
:DATE OF REQUEST.: TIME: f• C7
BY.: FOR LOCATION: # 3 �A_
DAY_ INSPEC. NEEDED_,- -gs _ TIME: oe4,
TYPE OF ZNSPECTIONs
SANITARY/LATERAL<f°PERMIT'NO,... } (:. ).;, FOOTING-.,DRAIN
( �) EXCAVATION '(PERMIT,-NO.- ) ( ) OTHER
i
;•, DATE: TIME: ► INSP:
f. CONTRACTOR=' WEATHER; ,' r�
WORK -IN PROGRESS
C-do'W,44 Sa
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: