HomeMy WebLinkAboutDrain Layers Permit 05 Bailey Circle TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7877 Contxaet'or` 15OUBLIE=.;;.0 CONSTRUCTION LLC
Location 0005 BAILEY CIRCLE A'rldres.s [ :; P `5::;:.45 EVANS RD
Type Work NEW SAN LAT g0CKY"'HIhh C.T``4.6067
`Phone-:No
Date Insp Insp
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• Permit No. 7877 Town of South Windsor, CT ,
Permit Date 02/14/2005 Drain Layer Permit
Expiration Date 03/16/2005
Descrip: INSTALL SEWER LATERAL
Applicant Lea ion
Name DOUBLE C CONSTRUCTION LLC' Ad Y 9Q:05 ATL Y CIRCLE
-, I
Addr. P 0 BOX 785 45 EVANS RD ;... Oxrsii�r SHADY BROOK ASSOCIATES LLC
ROCKY HILL CT O&Ob7
Phone No. ( )
The Drain Layer assgneii 4.hi5 p £ has a uaTi�i x.kcerise issued by the
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state and hereby agrees to '1 the "terms and cdndit3og set forth in the
attached 'Conditions' `,.All weirk sha:1 S� acordan e s�ith Pawn of South
Windsor standards, all OSHA :requir.' G,Ut� and Sha art
Windsor ('
Issued By i�c:✓�_- Ts t1 e f l �_ #C.-----------------
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Date Inspected In'sp* eed By
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4-7677
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: Lot
Street No. Street Name
Premises owned by:S hol cot 1 '2K-c c\ &S S,
Name of Firm: (' I e. C �o� S"�{ Phone:
Address of Firm: v, (2 c c k- t ff
TYPE OF WORK:
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_ Well
Proposed Start Date. _ �(-G5 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
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Permit is to be issued to0eci-v-\' l-r� ``� the holder of Drain
Layer's License No. oqoW f-6Cg . 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.
Signed: � Print Name:_(D'c" << S
Licensed Drain Layer
Date:r2- I LI -c z;
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
v 4 TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: — �l
BUILDING ADDRESS I Cl r
STREET
SUBDIVISION: in
NORTH ARROW
LA
Cc
CONTRACTOR (PRINT) NAME OF CONTRACTOR'S
SUPERVISOR (PRINT)
STREET ADDRESS SI RE
ace -`DATE
TOWN STATE ZIP INSPECTED BY TOWN
xj DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER