HomeMy WebLinkAboutDrain Layers Permit 20 Breezy Hill Drive TOWN OF SOUTH WIrJDSOR INSPECTION REPORT
Permit No . 7214 Contsractor INCORPORATED CONSTRU--�TMN
Location 0020 BREEZY HILL DRIv Adaress 11�': NORTHWOOD DRIVE
Type Work-. NEW SAN LAT BLOOMFIELD CT t i;sin
Phone No. ! ct bC) )24 -0 150
Gate insp Needed
Date ,Inca. I►1✓
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Time Insp Needed Time Trish. S
Inspected By . >f3�
Work in Progress
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Permit No. iQ14 nwn of South Windsor, -I'
Permit Date 11 %2012000 Drain Layer Permit
Expiration Cate 12/20/2000
De=:crip : USER FEE PAID CHECI,.. #796
App l i can Location
Name INCORPORATED CONSTRUG4ION Addr. 0020 BREEZY HILL DRIV
Adair . 12 NORTHWOCD DRIVE rjwner, HALL:,. �3RIAN C . &
BLOOMFIELD LET 00,02 `
Phone No. 1 850 24 '-o 7 r7U
The Drain Layer assigned this permit has a valIid incense issued by the
state and hereby agrees to ai1 the terms and concilti0f1s set, forth in the
attached ' Conditions ' . A i '1; v Q_,o sha 1 1 be in accordance with Town of South
Windsor, standards , alp OSHA requirements, and the attached conditions .
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Issued By may,
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Date Inspected
Inspected By 1{lam
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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: O 9 r -e e-1--* l 14-< < Lot #
Street No. Street Name
Premises owned by: 1(
Name of Firm: tic, o neol'afr l Coy s ,cvc1,-go., Phone: 9-Ya- of vc)
Address of Firm: ) a h o e oLt w o,
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date Estimated time for completion //- a l- -o
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 u&z,Y % kk, 1-16� ) the holder of.Drain
Layer's License No. Ro k .;iok o b? . Only holders of P1 or P7 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. _� o v a K rd v.;2 ?E
Signed: Oat, 4 jfe±y" Print Name: �' l��11 L,-
Licensed Drain Layer
Date: /I- 2- o — e
Standard Forms\Permits\APPLICAIION FOR DRAIN LAYERS PERMrT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: ) aD = � �
BUILDING ADDRESS : 9, 0 r V
STREET :
+ SUBDIVISION: t,
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT)
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STREET ADDRESS S104ATURE
6'h �•'z C v� C2 (,v v 6l 7,0 oh DATE
TOWN STATE ZIP INSPE D BY TOWN
i Y 6 6 I Lf - 0 S-6 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER