HomeMy WebLinkAboutDrain Layers Permit 8 Vincent Circle 64`17
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE:
Pursuant to written application, fe, mfssi Pq is hereby granted to the Licensed Drain Layer named herein to
perform work at C r�/� , Lot# as ndi ated below, a
premises owned by whose address is and
to Lay House Drain a air House Drain Lay Main , Other r
42046
occupancy or use, with` acres.
Type of Sewage to be connected under.this permit SAN/TARP SEWAGE( , INDUSTRIAL WASTES
OR (1 Connection will be made with :3 S . All
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 date3 Estima d time for completion
Permit is to be issued.to &d h rf a holder of Drain-Layer's License No....
2D ? Only holders of P1, P7 & W9 ceases will be issued permit. hermit will expire thirty (SO) -
days after dspe 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 receive Tow Street Excavation Pennit No.
and/or ConnDOT Permit No.
Signed
Licen Dre ayes
FOR TOWN USE Oft Y
Permit Fee Paid$ 42 _(Check No.)
Y�� N Connection Charge $ /o "8.7 T (Receipt No.) VX"/y Dated
Insurance on File
Bond on File (�( I Thin permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecticut and has on file,satisfactory bond
Premises subject to / and insurance in the name of the Town of South Windsor.
lntertown Agreement
Record of Sewer
Assessment (.1 ( 1 Issued by��, ...-w Date
INSPECTION'
Date Work Started gt, A-jr Date Completed r4lx p
Comments
APPROVED: '
Inspec r Date
f
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: S-/- 96 TIME:-
BY: FOR LOCATION:
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. 6->I/ 7 ) ( } FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
03
. DATE: TIME: INSP:
CONTRACTOR: WEATHER: ��' L� �-�„✓
WORK IN PROGRESS: ,
Q.0 T'o ES9c'.CF/L.L
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: