HomeMy WebLinkAboutDrain Layers Permit 09 Bancroft Lane a
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7737
Con tra_.Q: °- Y}yA ;;,, .CAVATING, INC
Location 0009 BANCROFT LANE :
P,dt3ress,� 139 CAST. G1z''A Y ROAD
Type Work NEW SAN LAT
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RANY CS.<703`5'>::.
Date Insp Needed33:
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Time Insp Needed
Inspected By
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Permit No. 7737 " Town of South Windsor, CT
Permit Date 04/21/2004 Drain Layer Permit {1!
Expiration Date 05/21/2004
Descrip:
Applicant dcation
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6:0.9 '4'ANCR�?`.M BANE
Name BEDNAZ EXCAVATING, y>TN� � ;%'��1 ,;�:?r``•"::.. Q.
Addr. 139 WEST GRANBY R(Ath: { s:x -t PQR�E$T MT-LLAGE,-, SSOCIATES LLC
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GRANBY CT 06(�35
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Phone No. (860) 653-25b3
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The Drain Layer"asiged this ed by the
state and hereby agrees tQ a ' the:;:k aaditiaterth in the
attached 'Conditiont' Ali WtYrC se , n#x b f an e frith T-%w, of South
Windsor standards, lx`'dSI7t<;' se"`: irements; and the ,.,€ taY% d :cpnd`itions.
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Date Inspected I.1s:: t e ---------- — ---------
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: /J�9�C�� .�
Lot #
Street No. treet Name
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Premises owned by: `
Name of Firm:
Phone.
Add ress.of Firm: �L�dsoc�/ a•4�
TYPE OF WORK:
Lay House Drain G ; Repair House Drain
Lay Main _ ; Lay Laterar for Commercial/Industrial
Building .of acres
Connection will be made with SZ) 3 5'
Existing Water Supply: Public Water __ Well
Proposed Start Date - `� a 'Ct_f 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 ✓J �i e 'mac q�/� the h
Layer's License No. aD� older of Drain
. 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:
Licensed Drain Layer
Date:
Standard Forms\Pere its\APPLICAj70N FOR DRAIN LAYERS PERMIT.doe
OF SOUTH WINDSOR
R LATERAL FIELD LOCATION
STRUCTION: -
BUILDING ADDRESS Z_ 6
STREET
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STR�ET ADDRESS SIGNATURE
3 -e J- 6f J'�� 61 rI�W� S^ D ATE
TOWNg STATE ZIP INSPECTED BY TOW
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER