HomeMy WebLinkAboutDrain Layers Permit 45 Vincent Circle 6402
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
:-BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT =°
DATE: �`
Pursuant to written application, rmission is hereby granted to the Licensed Drain Layer named herein to
perform work at `y : ' C/I indi ated be% , at
premises owned by S hose address is 1'7 and
to Lay House Drain R n it Ho use.P in , Lay Main ether r
occupancy or use, with
r
Type of Sewage to be connected under this permit.• SANITARY SEWAGE. �JNO USTR/AL WASTES(J,
OR f I Connection will be nte"de with 35 .° A#
work to be,in ac ordance with Town of South Windsor_standards, all OSHA requirements.` fifie""" d7*dd s
indicated on the back of thispermit. '
Proposed start date Est
/m ted time for comp/etion . I D
Permit is to.be.issued to' r��r , the holder of Drain Layer's License No.,
2a 30 Only holders of P1,,P7 & W91Z er)$e;vWill be issued permit. Permit will expire thirty 6M
days aher�d f issuance Theunrferslned rain Layer hereby agrees to a//the terms and conditions set
fofh-in, he permit and the reverse side thereof. Applicant has received Town Street Excavedon Permit No.
and/or ConnDOT Permit No.
Signed .�
YAucelodr Layer
FOR TOWN USE ONLY
Permit Fee Paid$ a •o v (Check No.)
Y N Connection Charge $ I 0 6 (Receipt No.) 60 Dated 3 26 c G
Insurance on File at 1
Bond on File a( I This 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.
Intertown Agreement Nl f 1
Record of Sewer
Assessment ( I I Issued by Date �3-29- 4
INSPECTION
Date Work Started rt3i / Date Completed o4 i y
Comment
APPROVE
znspe or Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: Z//9 6 TIME:
BY: .Ji%� FOR LOCATION: L'�✓�/i/����+✓i G iu��
�r
DAY INSPEC. NEEDED f/z/ TIME: w�J
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NOZ,110 7� ) ( ) FOOTING DRAIN
( } EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME:
CONTRACTOR: ,y'iyJ�' WEATHER: d ®✓,rz 04k,v>
WORK IN PROGRESS:
o.Q y co.•%r���Tio.�
s✓� rd-� fir/� �i✓ sy�z,� y-o ��sT sc s�i�! L�T
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: