HomeMy WebLinkAboutDrain Layers Permit Buckland Road at Hem TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 7917 >,.CONSTRUCTION CO
Location ` +R 'ROD AT HEMLOCK DRTrs 1 N �M;EQ DRIVE
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Permit No. 7917 Town of South Windsor, CT �
Permit Date 05/10/2005 Drain Layer Permit i
Expiration Date 06/09/2005
Descrip: INSTALL SEWER MAIN ACRQg BUQKLAND ROAD
Applicant " L'oation
Name GERBER CONSTRUCTT TT HEMLOCK DRIVE
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Addr. 1 NUTMEG DRIVE
ELLINGTON ` <s.. �'J ' ;'<.
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Phone No. (860)875-6:68�
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The Drain Layer as'Si" fj tl`t - is pe. m' •: .T valid> h:$e'ivs zed b the
state and hereby a ..e:.,s ...'s>?:. ; ".., , Y
y e .�a- a 'p'4> >:Ups t tditk i'r� set"`'forth in the
attached 'ConditiosY'.� >,P1: :5;ty�iYk Bpi& > �Ye:.: tc1iG€e:><x+rth Town of South
Windsor standards, :y:a7;3<=OS�: .Eagaaa ; :s ka hed<>dbAditions.
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Issued BY c 5 �,e� -�`
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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 $60.00
Location of proposed work: Po -/( ,k i t` SoG�
Lot #
Street No. Street Name
Premises owned by:
Name of Firm: 6:FC. fez,
�1I Phone:
Address.of Firm:
TYPE OF WORK:
Lay House Drain-1-/_. Repair House Drain
Lay Main_,&,--,' ; Lay Lateral-for Commercial/Industrial
Building of acres
12
Connection will be made with Aj
Existing Water Supply: Public Water Well
Proposed Start Date ��
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 64--M&. &AO T' 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.
Signed: Print Name:
Licensed Drain Layer
Date:_
Standard Forms\Permits\APPLICAIION FOR DRAIN LAYERS PERMIT.doc
054-10/2005 TUE 9:00 FAX 860 644 7280 South Windsor Town Hall IM002/002
TOWN OF SOUTH WINDSOR
SANITARY - SEWER LATERAL 'FIELD LOCATION
DATE OF CONSTRUCTION: ,
BUILDING ADDRESS : g U 24/4,h"//
STREET
SUBDIVISION:
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NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTO 'S SUP SOR (PRINT)
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STREET ADDRESS SIGNATUR
c `) DATE
TOWN STATE ZIP . INSPECTED BY TOWN
&6 U DATE
TELEPHONE NUMBER
WHITE - TOWN PINK. - CONTRACTOR YELLOW CONSULTING ENGINEER / DEVELOPER