HomeMy WebLinkAboutDrain Layers Permit 46 Vincent Circle e
TOWN OF SOUTH WINDSOR
DEPARTMENT OF PUBLIC WORKS
BUREAU OF POLLUTION CONTROL
DRAIN LAYER'S PFLRMIT
DATE:
Pursuant to written ap ticat-on, permpsion 's`hereby granted to the Licensed Drain Layer named`herein to
perform work at Lot# 9 as ind/ca ed elow, at
premises owned by Z rkhose address is S" £ r� and
to Lay House Drain R i dodsej,Drerh , Lay Main , Other for .
occupancy or use, with acres. 4 ^k ft
Type of Sewage to be connected`under this,Permit- SANITARY SEWAGE INDUSTRIAL WASTES-A
OR.(I Connection;will be:made with Al/
work to be in accordance with Town of South Windsor standards, a//OSHA requirements and the conditions
indicated on the back of this permit. wAN
Proposed start date 5 q'6 4stimated time for completion
Permit is to be issued to.;` the holder of.Drain'IiayO s License No.
,.Only ho/ders of P1,.,P7*& i�'S.li .nses, iil be�tssu permit. Aermit will expire thirty (301
days aftYafof issuance. The undersigned Dfain Layer hereby agrees to al/the terms and conditions set
forth in the permit:and the reverse side thereof. Applicant has received Town Street Excavation Permit No.
and/or ConnDOT Permit No.
.Signed ..
e s in: a
FOR TOWN USE ONLY
Permit Fee.Paid$ (Check No. /i
Y N Connection Charge S '600•o u (Receipt fibd Lt 60( Dated .3 r 4 6
Insurance on File A41 I y 5$,3"] 11 6 0 of
Bond on File (ul( 1 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 he,satisfactory bond
Premises subject to and insurance in the name of the Town of South Windsor.
/ntertownAgreement (✓I ( )
Record of Sewer fin,
Assessment ( I ( I Issued by, hloz) Date
INSPECTION
- Date Work Started 9/9'L Date Completed d z� 2`
Comments
APPROVED:
Inspec Date
SANITARY LATERAL & EXCAVATION PERMIT
INSPECTION REQUEST
DATE OF REQUEST: 0.3-z 5 z9 6 TIME:
BY: G G eK.s 0 c_ FOR LOCATION:
DAY INSPEC. NEEDED O3/ag, TIME:
TYPE OF INSPECTION:
( SANITARY/LATERAL (PERMIT NO. 0 y0-7 ) ( ) FOOTING DRAIN
( ) EXCAVATION (PERMIT NO. } ( } OTHER
INSPECTION REPORT
DATE:z 9 / TIME: � 3a - y. y — INSP: T L�1��B'•�/�
CONTRACTOR: WEATHER:
WORK IN PROGRESS:
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AREA OF CONCERN:
SPECIAL INSTRUCTIONS: