HomeMy WebLinkAboutDrain Layers Permit 35 Vincent Circle _c. "trt'•?'�ywy. r" "�'" �t�'�".d*k.'om.'; +c: {'P�'i s.�}? '
N 6415
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PERMIT 1
DATE: Z
Pursuant to written//cation, ,oermi ion is her by granted to the Licensed Drain Layer named herein to
perform wor at
�.�'C Lot# � as indi ated eI , at
irsetfi9, whose address is / o / and
to Lay House Drain , %e it House Drain , Lay Main Other r '
occupancy or,use, with acres.
00000r
Type of Sews a to be connected.under this permit.• SANITARY SEWAGE 1, 1NOUSTRIAL WASTES(l,
OR(1 _- Connection will be made with JP& 3 . .Al/
work to begin accordance with Town of South Windsor standards, all OSHA requirements and the conditions
indicated on the back of this permit.
Proposed start date 3 Estima ed rime for completion /
Permit is to:be issued to e .r ,the holder of Drain Layer's License No.
Only holders of P1; P7 & W9 Iic uses'wiI/be issued perma Permit will expire thirty (30)
days after date of issuance. The undersigned D ain Layer hereby agrees to all the terms and conditions set
forth in the permit and the reverse side thereof. Applicant has received To eet Excavation Permit No.
and/or ConnDOT Permit No.
Signed g
cen Drai er
FOR TOWN USE Oft Y
Permit Fee Paid$ ZI-or" (Check No.) /V174 6.010 r..3'7
Y N Connection Charge S/o >.3T (Receipt No.l *V l-y- Dated r
Insurance on File (✓t( l
Bond on File (✓f( I This permit is hereby issued to the above named Drain Layer who has a valid
license issued by the State of Connecdcutand has on file, satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
Intertown Agreement (�{
Record of Sewer
Assessment ( 1 ( 1 Issued by s Date .z3
INSPECTION
Date Work Started Date Completed A/ -Zg-fie
Comments
APPROVED:
Inspector Date
4
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: TIME:_ 8. 0
BY: FOR LOCATION: Lo> � �/��✓�6..✓�„�cCt
DAY INSPEC. NEEDED TIME:
TYPE OF INSPECTION:
( �/ ) SANITARY/LATERAL (PERMIT NO. 6r- 11-IS- ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. ) ( ) OTHER
INSPECTION REPORT
DATE: TIME: / %07 INSP:
CONTRACTOR: WEATHER: GUe7
WORK IN PROGRESS: r% wr3-1 elea sf�Y 2214y he�us r 7--j�3e
AREA OF CONCERN:
SPECIAL INSTRUCTIONS: