HomeMy WebLinkAboutDrain Layers Permit 109 Benedict Drive TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 7101 Contractor LATULIPE BROS. INC.
Location 0109 BENEDICT DRIVE
TYpe Work NEW SAN LAT Address 780 VERNON STREET
MANCHESTER CT 06040
Phone,
Po- (860)646-5114
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Per_rai•t No. 7101 Town of South Windsor, CT
Pkei, bit Date 12/07/1999 Drain Layer Permit
Ex9iration Date 01/06j20;00
Descrip;
Applicant Location
Name LATULIPE BROS. INC. Ad #r�= Q4.A9 BENEDICT DRIVE
Addr. 780 VERNON STREET wner :DOUGENIK JOHN C &
MANCHESTER CT e0$Q4
Phone No. (860)646-51 14
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tbs 'hasr dJ h c e n s e issued by the
The Drain Layer as �gr � � p
state and hereby agrdst o i� t 4 13e,,rm: -and ndl t ohs set forth in the
attached 'Cond i t i ons' A1� � -k s � b� a n aC" 10d4nc�9 with Town of South
Windsor standards, all'O$kA qu'trYerent3 ► 1dh'e ,attached conditions.
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Issued By
Date Inspeci,�d __ 1Z `� �"1� � S.nspep ad by
APPLICATION FOR DRAIN LAYER PERMIT
' TOWN OF SOUTH WINDSOR l d�
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, Cr
FEE $25.00
Location of proposed work: /0 o/ /3 E Pj - - Lot #
Street No. Street Name
Premises owned by: Ja N>y 6 o y G G r\J/ K
Name of Firm: 44%UL 1 ,PP e l3dic T H eR //I,t Phone:
Address of Firm: -7g o V6(� n10N SS 1 j')Igf\1)c G l
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with P. VC
Proposed Start Date ' g cl Estimated 1:�c
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 L.,g i uz+PPE the holder of Drain
Layer's License No. -.o 6 7 S g Only holders of P1, P7 &W9 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.
Si ned: �- 1Va8M z•g Tv�t
g �`�' Print Name: �11✓ Pf
Licensed Drain Lay r
Date: -2 q
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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' TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: Dec,
BUILDING ADDRESS OL*C-- No. C9
STREET DovL
-F SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
��ANra1i KKK �.r Q64� DATE
TOWN STATE ZIP INSPECTS BY TOWN
646�-a 114- DATE
TELEPHONE NUMBER
WHITE - TOWN PINK CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER