HomeMy WebLinkAboutDrain Layers Permit 59 Bailey Circle Permit No. 7798 Town of South Windsor, CT
Permit Date 08/19/2004 Drain Layer Permit
Expiration Date 09/18/2004
Applicant sN01.
Location
Name DOUBLE C CONSTRUCT O T� rLC,sf 1.LEY CSI'iqLE
Addr. P O BOX 785 45 EUiND4 4SHA�3 B2QQK A$ O IATES LLC
ROCKY HILL C� 0606 7 { . f y
Phone No.
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The Drain Layer assag`ila the permit ls �zalad 1p� s assud by the
state and hereby a�xep� ' ..1. " r'& '
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 7798 Cont " CONSTRUCTION LLC
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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 ro w 58
P p work: Lot # 1�p
Street No. Street Name
Premises owned by: arG�,
d z /S G
Name of Firm: (DLL -:I-e CO eL E4 Phone,.Qj
Address.of Firm: Lt o f2d
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main ; Lay Lateraf for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water S Well
Proposed Start Date '-t —estimated time for completion cla
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 0-,qcch, C01(tZX(' 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.
Signed:111 Print Name: r
Licensed Drain Layer
Date: l
Standard Forms\Perniits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
• SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS .
STREET
SUBDIVISION: Spa
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIG RE
�dGIIC �I ► 0-F I ft9�•� DATE
TOWN f STATE ZIP INSPECTED BY TOWN
S a DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER