HomeMy WebLinkAboutDrain Layers Permit 59 Bailey Circle (2) 1
I TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No 7762
con or DOUBLE- NSTRUCTION LLC
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Type Work NEW SAN LAT " Y
CT 05 67
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Permit No. 7762 Town of South Windsor, CT
Permit Date 07/01/2004 "" `"""'° :>::,.., Drain Layer Permit !1
Expiration Date 07/31/2004 ;
Descrip: INSTALL SANITARY LATERAL
Applicant `y' `:
PP >r w` Y4` > LQakt'3.on
Name DOUBLE C CONS TRUCTIfs�N � pASf
Zd---, z � � � .*A�liE7t +hCliE
Addr. P O BOX 785 45 Ek7ANS"1 Ti "';"'":; ' t r SHADY ROCK�AGSOCPATES LLC
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ROCKY HILL -C.T "� "K3�". .I:
Phone No
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The Drain Layer ``as 'gne „Y 's:>'` 'h '.s' .d lxcez��51e e.sued by the
state and hereby agreewAtt' 1`:; he ims n' Y C'2ti e 3"t ?ri t.;'for h in the
_ Y'=
attached 'Conditions,. Y1`%Kar }k4, ia >I,"'" � „ "�1feri °:skthi�+n of South
Windsor standards, all OSHA A.uii:em m�
ari[1@ attadhec cbtiitions.
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Issued By Date Inspected --------------------- T`i spee� E4'>-: y - --
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:_ Lofi # Q
Street No.
Street Name
Premises owned by: haA
�
Name of Firm: ib� C �n sa'�,� ,« Ph
one:. -U -1SQ3
Address:of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main------- ; Lay Lateral for Commerdal/Industrial
- Building 'of acres -
Connection will be made with
Existing Water Supply: Public Water_ti/ = Well
Proposed Start Date_441byEstimated time for completion /I&I
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. --?.77q 7 Only holders of P- ; P-7 or W-9 licenses
will be issued a permit. PERMIT WILL EXPIRE THIRTY(39)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:_ Lhr�5
Licensed Drain Layer
Date:__
standard ForMAPerrnilAAPPLICATtON FOR DRAIN t:AYERs PERmIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: "l ''®
BUILDING ADDRESS . 60,1' lfel
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STREET
SUBDIVISION: ev
NORTH ARROW
1114,00
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CQ 5W.0 tt4T JPA{�j� NAME OF CONTRACTOR' SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
pde-116 ?, jay DATE
TOWN STATE ZIP INSPECTED BY TOWN
- 3 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER