HomeMy WebLinkAboutDrain Layers Permit 157 Burgess Road TOWN OF SOUTH WINDSOR INSPECTION REPCRT
Permit No. 7189 Contractor GERBER CONSTRUCTION CO
Location 0 15 7 BURGESS ROAD:` Address- .;� 616 DART HILL ROAD
Type Wore RPR SAN LA1" ' ' VERNON CT 06066
Phons No. ( 860 )875-6684
Date Insp Needed Date 1115p.
Time Insp Needed Time Insp.
Inspected By
Work in Progress
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Input __--.._____------ Date
Perrni t No. 7 ,i89 i own of South Windsor'. 07
Permit Gate 09/29/2000 brain Layer Permit
Expiration Date 10/29/2000
Descrip : INSTALL SEDIMENTATION STRUCTURE
Applicant Location
Narne GERBER CONSTRUCTION CO Aadr. 61-57 BURGESS ROAD
Addr . 616 DART HILL ROAD Owner SOUTH WINDSOR TOWN OF 61
VERNON CT ;06666:
Phone No. (860)875-6684
The Drain Layer assigned this permit has a valid license issued by the
state and hereby agrees , to al 1 the 'terms and conditions set forth in the
attached 'Condit.ions ' . All work shall be in accordance with Town of South
Windsor standards, all" OSHA requirements, and the attached conditions .
Issued By ( rL7Jh Tit 1 eil �a 1j ",F -
7+ r —
3 ®1 �.�.
Date Inspected Inspected .By
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 Lot #
Street No. Street Name
Premises owned by:
Name of Firm: A Phone: OD/
Address of Firm: �� l�.�J V t�fLN��✓
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with eyz-'
Existing Water Supply: Public Water. Well
Proposed Start Date`�-�P Estimated time for completion % �G
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
I
Permit is to be issued to the holder of Drain
Layer's License No. f9 zcs-5'`l - 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.
Signed:. Print
9 nt Name:
Licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS'PERMIT.doc