HomeMy WebLinkAboutDrain Layers Permit 0210 Avery Street I
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7638
Location
Contra`�tor SIMMONS:;.PAVING, LLC
0210 AVERY STREET Address 20.EA52:: NEW°BERRY RD
Type Work NEW SAN LAT
3:�OOMFIELD CT ..6002
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Permit No. 7638 Town of South Windsor, CT
Permit Date 06/11/2003 Drain Layer Permit
Expiration Date 07/11/2003
Descrip: CONNECT TO SMH IN ROAD_
Applicant LcCat:aon
Name SIMMONS PAVING, 1L0 Adder 0. 1'0 AVRY ST1Z: ET
Addr. 20 EAST NEWBERRY RD Own:ex.;._,.GLAST4)NBURY BUILDERS LLC
BLOOMFIELD CT., 06002
Phone No. ( )
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The Drain Layerassigned tis pexsnat haS d u1d XiCense"issued by the
state and hereby agree to ail< the...........
erms and condxtlons set_:;forth in the
attached 'Condition Town of South
Windsor standards, a1.1 OSHA xequxreenents anri the attached^conditions.
Issued By ""'� 1 + Title
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Date Inspected _____________________ Inspected By —__—__—________--____ ---
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work:_ �Z/ p f �-f S Lot #
Street No. Street Name
Premises owned by:
Name of il"ALTPv6 L L C PhoneCj�D 616Y
Address.of Firm: 6,A2 6f( � ..
TYPE OF WORK:
Lay House Drain_; Repair House Drain
Lay Main Lay Lateral for Commercial/Industrial
Building of acres
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Connection will be made with 6
Existing Water Supply: Public Water ✓ Well
Proposed Start Date Estimated time for completion. 61,24—co
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to the holder of Drain
Layer's License No. Only holders of P-1, P-7 or W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(30)'DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
and conditions set forth in the permit and attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD NO. -�� �fb0 6 6 t2•
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Signed: Print Name:
icensed Drain Layer
Date: k 9` 2AMZ.
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY- SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 1.2(k 103
BUILDING ADDRESS Ayf-2 V STR FF-T
STREET Av10 CTR FT
SUBDIVISION:
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