HomeMy WebLinkAboutDrain Layers Permit 47 Shares Lane 632
TOWN OF SOUTH WINDSOR ,
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT �--
DATE:
Pursuant to written application, erm rion.is hereby granted to the Licensed Drain Layer named herein to
perform work at Lot# W as indicated below, at
Premises owl7e40y whose address is d
to Lay House Drain , Repair Houefe Drain Lay Main Oth r for
occupancy or use, with acres.'
Type of Sewage to be connected under this permit.• SANITARY SEWAGE( , /NDUSTR/AL WASTES l J,
OR f J Connection will be made with A/l
work to be in accordance with Town of South Windsor standards, a//OSHA requirements and the conditions
indicated:on the back of this permit.
Proposed start date ' Estimated time for completion C7 .
.be issued to /1/f-LA', Ct ' S the holder of Drain Zayer's License No. -
Only holders of P1 -7 & W9 licenses will be issued permit. Perm/t will exyire 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 riewme side thereof. Applicant has a own S vat/ 'Permit No.
and/or ConnDOT emit No.
Signed
Licensed Dr in Layer
FOR TOWN USE ONLY
Permit Fee Paid$ ? 5. 00 (Check No.) tf Z 7 PA 9-14-95
Y N Connection Charge $ C20o,b n (Receipt No.) Dated 9-T
Insurance on File
Bond on File 447 l This permit is hereby issued to die above named Drain Layer who has a valid
/loense issued by the Slate of Connecticut and has on file,sedsfactory bond
Premises subject to and insurance in the name of the Town of South Windsw.
Intertown Agreement ( J ( l
Record of Sewer
Assessment Issued b Date
INSPECTION
Date Work Started 9' 9 5 Date Completed Z9 9-5-
Comments
APPROVED:
9- 15_
Inspector Date
• SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST:
(4-9 S TIME: f 00
BY: Do:�V4,p/
R FOR LOCATION: VA 4 �
DAY INSPEC. NEEDED 9 -r�--9S TIME:
TYPE OF INSPECTION:
(� ) SANITARY/LATERAL (PERMIT NO. CO 3 2 ) ( } FOOTING DRAIN
( } EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 9 TIME: 31, ccINSP:
CONTRACTOR: WEATHER:
IF
WORK IN PROGRESS: Zw"gzs�m- -A&Z 44�02n a
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
P