HomeMy WebLinkAboutDrain Layers Permit 25 Vincent Circle yw-yy.� - 1. �P��'TSS a' 'Y�PX.}';D »'C.'Y6. - �, „ .. ... '1.. ..- ... - .. t•„
6416
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT
DATE: 2
Pursuant to written plication, per /ssio is fjereby granted to the Llcens d Drain Layer named b eto
perform work at ee Lot# as/ndicat d bel
premises owned by whose address is and
to Lay House Drain , Repair House Drain , Lay Main , Other fo
occupancy or use, with acres.
Type of Sewage to be connected under this permit.- SANITARY-SEWAGE(1, 1NDUSTRIAL WASTES(9,
OR{I _f__:` Connection will be made with $ 2 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 date 3 Estimated me for completion
Permit is to be issued to vC°' J f rj Cie holder of Drain Layer's License No.:
2089 30 . Only holders of P1, P7 a Wo Acensef will be issued permit. Permit will expire thirty (30)
days after.date of.issuance. The undersigned Drain L yer hereby agrees to all the terms and conditions set
forth in the permit and the reverse side thereof. Applicant has races ed TO treat Excavation Permit No.
and/or ConnOOT Permit No.
Signed f
Licen rain er
FOR TOWN USE ONL Y
Permit Fee Paid$ zS- (Check No.)
Y,�N Connection Charge $ i Receipt No.) Vjr13' Dated
Insurance on File (�/I I 1 /os"a''.-T7
Bond on File (,fJ ( J This penn'it is hereby issued to the above named DWn Layer who has a valid
license issued by the.Stage of Cmume "and has on file, sadsfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement W'l J
Record of Sewer
Assessment O ( 1 Issued by �- -;g* , Date VIZ
INSPECTION
Date Work Started ag`xg: 9pe, Date Completed pe
Comment
APPROVED:
Inspector : Dat---e-�/
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST:��L-3 1,7e.- TIME: ss ,s o
st Zv`r
BY: FOR LOCATION:
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( r/) SANITARY/LATERAL (PERMIT NO. E//5' ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: INSP: �;L�v Pie-.✓>r
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: