HomeMy WebLinkAboutDrain Layers Permit 96 Birch Hill Drive .. TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 7743 Contraq_.:car«-S'KI:PS::«..4EPTIC
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Location 0096 BIRCH HILL DRIVE A}d4''ess. a,�27 M:v:DDY. .Biz-O?K ROAD
Type Work NEW SAN LAT O'6:0.29
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Permit No. 7743 Town of South Windsor, CT
Permit Date O5/07/2004 Drain Layer Permit
Expiration Date 06/06/2004
Descrip:
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Applicant Laa, aVion
'� . , . '`H•.H li L' B,.R IVEName SKIPS SEPTIC R
Addr. 27 MUDDY BROOK R:"AD't "0:
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ELLINGTON
Phone No. 860 875-23
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The Drain Layer ' s t::`s::.>::':e: '' '' : d ee', s
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state and hereby agf;.ees ;tE��;;�X�J.,;.;t e.».�.��5.���t�;"�04 ,4 �::.;�..: G
attached 'Conditions% }� 1 vstYrlyk�a�1bn acsaat� with"' urh of South
Windsor standards, alb. 0S11A.-.re°ct� t1fa3Yts t'he::.atta _h'ec1' conditions.
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Issued By 3 ""i /✓y----------------
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Date Inspected "
t743
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1.540 SULLIVAN AVENUE
SOUTH WINDSOR, Cr
FEE $60.00
Location of proposed work:_ c71 zC, Lot #
Street No. Street Name
Premises owned by: 2,,e/e -7 4 ,u L
Name of Firm: <Ce(PS 5PFP 7C 57Efc v/c PPhone:
Address..of Firm: 27 Au.Dpy zOdk ILA Le-�N G' Ta n/
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main
Building Lay Laterar for
Commerdal/Industrial
Connection will be made with Pvc-
Existing Water Supply: Public Water x Well
Proposed Start Date P� Estimated time for completion
ALL WORK-TO BE IN ACCORDANCE WM'TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit-is to be issued to0�'�► 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. _ moo¢- 190 ,21 Z�
Signed.
Print Name: 7?hi9-r G✓q)-x-£1z- (i A-
censed rain Layer
Date:
:Standard Forms\Permits\APPLICAlION FOR DRAIN LAYERS PERMIT.doc
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