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HomeMy WebLinkAboutDrain Layers Permit 17 Spinners Run t TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S PERMIT , 6037 Jig kt"n - , 19 i.3 Pursuant to written application, permission is hereby granted to the Licensed Drain Layer :famed herein to perform the work indicated below at 4,)4 2_ 5)0//v 1y Y_S at premises owned by DeN l + 0e6 19 r;I v(/U whose address is and to Lay House Drain, Repair House Drain, Lay Main, Other s wC,, for occupancy or use, with Family Units, with acres. Type of Sewage to be connected under this permit: SANITARY SEWAGE INDUSTRIAL WASTES ( ) , OR ( ) Co ectian will be made with 677 Puz j o e Show sketch of proposed work or furnish 'two (2) copies of separate drawings. SPECIAL CONDITIONS OSHA REQUIREMENTS MUST BE FOLLOWED Desired Starting Date Moo C Z Estimated Time for Completion Permit to be issued to -Y f) rJ JC K JB the holder of Drain Layer's License No. Permit will expire thirty (30) 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 Town Permit No. and/or CHD Permit No., Signed Licensed Drain Layer The above named Drain Layer has a valid license issued by the State of Connecticut and has filed a satisfactory bond and insurance policy in the name of the Town of South Windsor: E gineering Dept. Date Permit Fee Paid $ a,17.00 Check Number Connection Charge Receipt No. �, Dated Issued by INSPECTION Date work started Date completedd Sufficient motif icac on r ce ve : ,_ es No Special Conditions APPROVED: Inspector Date ' SANITARY LATERAL & EXCAVATION PERMIT INSPECTION REQUEST DATE OF REQUEST: Z f O-a 3 TIME: BY: rGJZO FOR LOCATION: G�Z ����`��S /�-✓ DAY INSPEC. NEEDED TIME: TYPE OF INSPECTION: ( SANITARY/LATERAL (PERMIT NO. 62 ) ( ) FOOTING DRAIN ( ) EXCAVATION (PERMIT NO. ) ( ) OTHER INSPECTION REPORT DATE: 93 TIME: 1©:,�ro INSP: CONTRACTOR: WEATHER: WORK IN PROGRESS: fe.,—U C-) t i AREA OF CONCERN: SPECIAL INSTRUCTIONS: i