HomeMy WebLinkAboutDrain Layers Permit 49 Shares Lane .L7." '-."f.�r,4'�P•i'i+'e7lp'-` ;°jivaylF""_ .` gP,',°a6R€ �t`Py�3+ 'F,'s• tiF?�``s '} °s'°,.dk''R44'x2i+.F�lg", -1s.;:ic r.-�A' ` . .gym. - .. , ',':
6327
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
�9 DRAIN LAYER'S PERMIT
DATE: /
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to
' perform work at .i2alf/'I=/? f? "`� , Lot# as indicat e%v 44
,�
premises owned y w' �'� �r` " whose address is i/> �` cyan&rQ•G
to Lay House Drain epairH se Drain , Lay Main , O er , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE l , /NDUSTR/AL WASTES 11,
OR {J Connection will be made with . 'A#
work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions
indicated on the back of this permit.
Proposed start date -� —Jr Estimated time for completion
Permit is t be issued to1G holder of Drain Layer's License No.
. Only holders of Pf & W9 licenses will be issued permit. Permit will expire th/rty (30J
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 ce7iri Town Str t Excava Permit No.
and/or ConnDOT Permit No.
Signed --
censed rain Layer
FOR TOWN USE ONLY
Permit Fee Paid s 7z S,on (Check No.)
Y N connection 9 r orge $ D (Receipt No.) 4 S Z 4_Dated—A
Insurance on File ip
Bond on File ?pfJ! I This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Coruedcut and has on NO,se sfactwy bond
Premises subject to and insurance in the name of the Town of South Windsor.
/ntertown Agreement ( 1( J
Record of Sewer
Assessment ) O Issued by Date, ( _
INSPECTION
Date Work Started Date Completed
Comments
APPROVED:
Inspector Date
w SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: �—= erg• TIME:
'BY: FOR LOCATION: `
DAY INSPEC. NEEDED 2— /4^9 5 TIME:
TYPE, OF INSPECTION:
( �O SANITARY/LATERAL (PERMIT NO. (D3 Z-7 ) FOOTING DRAIN
( `` ) EXCAVATION (PERMIT NO. ) ( ) OTHER
p INSPECTION REPORT
DATE: S / S TIME: I 1" 4 O INSP:
CONTRACTOR: �i(�' WEATHER:
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: