HomeMy WebLinkAboutDrain Layers Permit 59 Shares Lane . '3o'v,;-,p. per,. .. ♦
6332
TOWN_OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
LAYER'S PERMIT
RMTT
DATE: f /�' �
Pursuant to written application, permission is hereby granted to the Licensed Drain Layer named herein to
perform work at !Y f`i' ` Lot# as indica_tgd b /o fat
premises ownedA whose address is.
to Lay House'Drain ;'Repair Hou a Drain , Lay Main Oth r , for
occupancy or-use, with acres.
Type of Sewage to be connected under this permit.• SANITARY SEWAGE NDUSTRIAL WASTES(1,
OR (J Connecdon wi/Lbe made with Y All
work to be in accordance with Town.of South Windsor standards,all OSHA requiremen nd the.conditions
indicated on.the back of this permit.
Proposed start date 4 Estimated time for compledon f S
Permit is to be issued to . li,�cdr holder of Drain Layer's License No.
Only holders of P 1 7 W9 licenses will be issued.permit. Permit wil/axnire thirty (30)
days after gLate 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 has Town Str t va ` Permit No.
and/or ConnDOT Permit No.
Signed
Licensed Drain Layer
FOR TOWN USE ONLY
Permit Fee Paid$ 2 57,d a (Check No.J a 7 -9
Y N Connection Charge $ 67 6 boo a (Receipt No.) Dated 9�1
Insurance on File (J ( J Z.;44f , , �9
Bond on File AA ( This permit is hereby issued to the above named Dam layer who has a valid
YV
license issued by the State of Conner but and has on Me, satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
lntertown Agreement ( I
Record of Sewer
Assessment 0 ( ) Issued by Date 9-149-5
INSPECTION
Date Work Started —f9 ���•-9 5 Date Completed 9 - --95'
Comments
APPROVED: 957
Inspector Date
SANITARY. LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUM7 TIME': / O O
BY: FOR LOCATION.
DAY INSPEC. "NEEDED 2- y—25 TIME: xi
TYPE OF INSPECTION:
( X) SANITART/LA:TERAL- (PERMIT"°NO ' 3 Z ) ( } FOOTING_-DRAIN,
( ) EXCAVATION (PERMIT NO. ) { ) OTHER
INSPEGTI0l4 RR�EPOR•T
DATE.: -- / TIME: 7 c® In SP
r. CONTRACTOR.-.;., 75
r WORK IN- PROGRESS:
1/1 Z�� f
ZL .
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: