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HomeMy WebLinkAboutDrain Layers Permit 30 Stonefield Trail 1M ?' R 7: k, `- --64-09 TOWN OF SOUTH WINDSOR DEPARTMENT OF PUBLIC WORKS BUREAU OF POLLUTION CONTROL DRAIN LAYER'S DATE: / 6 Pursuant to written a don, per iss/on is here y gr to to the cense Drain Layer named herein to perform work at 3b s �ot# as indicated below, at premises owned by v) S Ow whose address is and to Lay House Drain !r;Repair use Drain Lay Main , Other , for occupancy or use, with acres. Type of Sewage to be connected under this permit.• SANITARY SEWAGE. , 1NDUSTR/AL WASTES(J OR.{I Connection will be made with fir' /"V 4--. All work to be in accordance with Town of South Windsor standards, all OSHA requirements and the conditions indicated on the back of thist permit. Proposed start date 74 Estimated time for completion Permit is to be issued to r •,'t the holder of Drain Layer's License No. 2- ow Y Z✓. ' Only holders of P 1, P7& W9 licenses will be issued permit. Permit will expire dirty(301 days after date of issuance. The undersigned Drain Layer hereby agrees to all the terms and condons set forth in the permit and the reverse side thereof. Applicant has rec ived Town S . et oe7vadon Permit No. and/or ConnDOT Permit No. Signed �`'�" Licensed Drain Layer FOR TOWN USE ONLY Permit Fee Paid$ Z,j-'*e" (Check No.) Y N Connection Charge$ --(Receipt No.) ©Ho0 Dated Insurance on File (rl ( I Bond on File This perinit is hereby issued to the above named Drain Layer who has a valid license issued by the State of Connecticut and has on fife, satisfactory bond Premises subject to and insurance in the name of the Town of South Windsor. Intertown Agreement ( ) Oa Record of Sewer Assessment ( I ( I Issued by AO LI-1 Date INSPECTION Date Work Started off- - Date Completed o 5/=o Y--g'e" Comments APPROVED Inspects Date F , - SANITARY LATERAL.& EXCAVATION PERMIT INSPECTION REQUEST Y DATE OF REST: -y/ S G TIME: BY: jzp.�/ �� L�� FOR LOCATION: r DAY INSPEC.` NEEDED /7(f 4 TIME: &-144 + TYPE .OF INSPECTION: ( y— ) SANITARY'f7jAXERAL:_ '('PERMITY'Nd. " �yUU ) (,_=. } FOOT:INr. DRAIN.: t - ( ) EXCAVATION (PERMIT NO } ( ) OTHER INSPECT40N,-REPORT,. _. DATE: o a TIME: /o-i6-3o y� y�9G .�.30 - y INSP: r, �- ✓0-✓6 A,•K CONTRACTOR`: WEATHER:.: WORK IN PROGRESS-. s,v.•�. sc�sL Q -Biv�.r.so.� n P�,ewrri.Z s>c✓� GE,eBE.z s�.o ,6.z Y - �^.�ty6'L e-C sir✓iyr®� ^vas T!"�i�t Mo✓�I. �L C/�iLbd> Gie®�+! C'!i✓>�2 or�7:8�✓Es-✓/�Y Td AREA OF CONCERN: SPECIAL INSTRUCTIONS: