HomeMy WebLinkAboutDrain Layers Permit 0661 Avery Street TOWN OF SOUTH WIy`NDSOR INSPECTION REPORT
,Permit No. 7901 Cgn>'ractpz LANP:IEV t&-RSTRUCTION, INC.
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Location 661 AVERY STREET a 1lcadrez 21` I, Rk $OAS,:;.
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Permit No. 7901 Town of South Windsor, CT
Permit Date 04/14/2005 Drain Layer Permit
Expiration Date 05/14/2005 w> , z
Descri DISCONNECT EXISTI 4' S1IIXRY,:.> EAT
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Applicant
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' '�'�Tt8ETLANDIECONSTRU `.......Name
Addr.. 21 CLARK ROAD H
+HRI,R'T2F1 T::::IttFORMELI CHURCH
M. F
BOLTON CP, CJ6g4f
Phone No. 860 64 6 4` 0
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The Drain La er'*ass.a' cf': ''`i e>s?o. >.>:>:r:, *.,•.s:> .:>:;::..
sited by the
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state and hereby .. , yz�u�; 3is:<se "<': orth in the
attached 'Conditions'
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Windsor standards, al"1, OTA'xetui: " t >'<= F} ye attac;Yie "'°Conditions.
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Date Inspected ....----------------- Inspected By —__--------------------_--
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: 16 .5 7.ee,,7 Lot #
Street No. Street Name
Premises owned by: J-7,-Ce.7 clil',rT��� ,�� iti�-cp ci✓vz��
Name of Firm:__ 1 Pt.vo hT 4. Phone: 4L 5' 073/
Address.of Firm: 6"el 0)-'FJC6 or .?79
TYPE OF WORK: 016 llP E' e/9-P f(,5Cweo- BorLDIt/6.
Lay House Drain Repair House Drain
Lay Main ; Lay Lateral-for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water X Well
Proposed Start Date Estimated time for completion
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. _FO/-a o 3 7 t6 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
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Town Street Excavation Permit No. �-""' and/or ConnDOT Permit No.
CBYD No. 2 00S I S0137,07
Signed: Print Name: DAIJ 0 ►.J.
Licensed Drain er
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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