HomeMy WebLinkAboutDrain Layers Permit 0510 Avery Street TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. Cont xaor SKIPS SEPTIC
Location uA*i S STREET 7kddrea.O.:e 27 MUDD*<BR60K ROAD
Type Work NEW SAN LAT ',7,,,LNGT�N,E�T ;060Q9
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Date Insp Needed Date Insp
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Permit No. 8032 Town of South Windsor, CT
Permit Date 03/10/2006 Drain Layer Permit
Expiration Date 04/09/2006
Descrip:
Applicant L o"va t'ion
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Name SKIPS SEPTIC d 053O AVERY .ST1iEET:
Addr. 27 MUDDY BROOK ROAD " ""::_ '' O4t ter STEELE`: RRGQRY'"J S: DOROTHY J
ELLINGTON CT 86U29
Phone No. (860)875-2332..-, ""
The Drain Layersicned tki sem lzseJd li.gens0 ,�ssued by the
state and hereby agrees. tc5, 7 the t'zrms s'nd ccsYztih'n: _. et_:forh in the
attached 'Conditions' ,.A 1 Mr. dance wX th f6wh of South
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Windsor standards, all:. OSHA'�req-uire_m' 0g( aids? kr ""atGa ked::.conzlitions.
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Issued By --------- d Txt W
Date Inspected -------------------- IdtedfBy ---------------------------
APPLICATION FORD RAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: .�-/o
Street No. Street Name Lot #
Premises owned by: G Z F'G
Name of Firm: S S Phone; rz 3 3
Z
Address-of Firm:
TYPE OF WORK:
Lay House Drain__)/I,--; Repair House Drain
Lay Main • Lay-.Lateral-for Commercial/Industrial
Building of acres
Connection will be made with FV'C
Existing Water Supply: ' Public Water Well
Proposed Start Date(-� o 6 Estimated time for completion Z -�
ALL:WORK TO BE IN ACCORDANCE WITH'TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit-is to be issued to j1����
�— the holder of Drain
Layer's License No. z z . Oni holders of P-i P-7 or W-9 lice se$
will be ssued.a Y. n
permit PERMIT WILL EXPIRE THIRTY(3o)'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.
Town Street Excavation Permit No. Applicant has received
and/or ConnDOT Permit No.
CBYD No. o9-cd C o?o
Signed: Print Name: _77�4 Go -lc
Lic used Drain Layer
Date: 3,/,1 ,1
Standard FormS\Permits\APPUCATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE. OF CONSTRUCTION 3 / 'C
BUILDING ADDRESS : ` �'`!1 )4ilwd z4
STREET
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT) z
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STREET ADDRESS IGNATURE
j c DATE
TOWN STATE ZIP INSPECTED BY TOWN
- DATE
NUMBER
;OWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER