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HomeMy WebLinkAboutDrain Layers Permit 27 Bramblebrae TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No. 7415 Contractor HOMEOWNER J Location 0027 BRAMBLEBRAM. Address SAME AS ABOVE Type Work NEW SAN LAT SAME AS ABOVE SOUTH WINDSOR CT 06074 o. (000)000-0000 l Date Insp Needed I/Qs .4 Time Insp Needed p ; v ea <• Inspected By .,rr Work in Progress "4 n ©✓ Date Town of South Windsor, CT P�p�,�hNQ, 7415 Permit Date 05/01/2002 Receipt - Drain Layer Expiration Date 05/31/2002 Descrip: Name : HOMEOWNER yo AgreementN Type CK Property Address 0027 BRAMBLy doolit User Type RESIDENTIAL P/R User Fee Connection Charge Paid Permit Fee Paid n Total Paid Tendered:CK z SOR- Co '�' APPLICATION FOR DRAIN LAYER PERMIT TOWN OF SOUTH WINDSOR PUBLIC WORKS DEPARTMENT TOWN HALL 1540 SULLIVAN AVENUE SOUTH WINDSOR, CT FEE $25.00 Location of proposed work: 7-7 LIV, -r Lot # Street No. Street Name Premises owned by: C 1AS 4 kr F AC�14A e, Name of Firm: . Phone: Address of Firm: TYPE OF WORK: Lay House Drain Repair House Drain Lay Main ' Lay Lateral for Commercial/Industrial Building of acres Connection will be made with Proposed Start Date Estimated time for completion ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WIN'DSOR STANDARDS, ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT Permit is to be issued to the holder of Drain Layer's License No. 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. Signed: Print Name: Licensed Drain Layer Date: Standard Forms\Permits\APPLICA1T0N FOR DRAIN LAYERS PERMrT.doc TOWN OF SOUTH WINDSOR SANITARY. SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION BUILDING ADDRESS �� H-► STREET . 7 �Qa -I- SUBDIVISION: NORTH ARROW I f s __. I � , ----- _..__ t f f ff t , + t I ! t } { I - � 1 ' r I 1 f i+ i i 1 i r f ��✓/� ll�t��'`-�� �jLv/+'jam ��''� CONTRACTOR (PRINT) / NAME OF CONTRACTOR'S SUPERVISOR (PRINT) STREET ADDRESS - SIGNATURE N, ��• � d 7 DATE T WN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER