HomeMy WebLinkAboutDrain Layers Permit 53 Shares Lane .f1Si`s�s}^'mbar}"lS �,'�^x:-xm. .. - - f�' _`4. -, .. ` 'A .. ,. •.s�
6329
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT L�
DATE:
Pursuant to written application"', perr {ssion is hereby granted to the Licensed Drain Layer named!herein to ,
perform work at ,,7l k1v -� 3 f9 Lot# i� ' as indite p l a 'f
premises owned y $whose address is
to Lay House Drain Repair Homfe Drain Lay Main , O er , for
occupancy or use, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE NDUSTR/AL WASTES!J,
OR f J Connection will be made with " ef All
work to be in accordance with Town of South Windsor standards, all OSHA requiremen d the conditions
indicated on the back of this permit:
Proposed start date -Estimated time for completion
Permit 'to,be issued to At l /I ro.X Vie'holder of Drain Layer's License No.
,20 . Only holders of P1, 7 W9 licenses will be issued permit Permit will exoire thirty (30)
days after_date of issuance. The un ersigned Drain Layer hereby agrees to all the terms and conditions set
forth in the permit and the reverse side thereof. Applicant he -Received T wn Sheet adon P nnit No.
and/or ConnDOT Permit No
Signed '
censed DraM Layer
FOR TOWN USE.ONLY �r.•�'���i
Permit Fee Paid $ JI Z S.CM (Check No.) �Z; 9'-1 J -9 S
Y N Connection Charge $ rt5no, e o (Rec pt No.) 4 Dated 9- X
Insurance on File K1 ( ) �y tm * e/vJ
Bond on File /X1 ( 1 This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Owumdeut and has on fide,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
/ntertown Agreement l I (xJ
Record.of Sewer
Assessment I1 (:1 Issued by , Date S
INSPECTION
Date Work Started 9/92 57 Date Completed
Comments
APPROVED:
Inspector Date
' SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: !-T TIME:
BY: p, FOR LOCATION: / r
DAY INSPEC. NEEDED g - / �^- !s TIME: O7
TYPE OF INSPECTION:
( ,.!f } SANITARY/LATERAL (PERMIT NO. ?j Z _) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: 2 9 TIME: 0 INSP
�"
CONTRACTOR: WEATHER: 7 J *L
WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: