HomeMy WebLinkAboutDrain Layers Permit 343 Clark Street TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7927 :„:
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dt<YactoZ JAMES�` R.OWE
Location 0343 CLARK STREET
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Permit No. 7927
Permit Date 06/06/2005 Town of South Windsor, CT
Expiration Date 07/06/2005 Drain Layer Permit
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Applicant %
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N >s'ame JAMES ,< n ,;:
THROWE ;�� .... ;.
ddr. VANS SEWER & SFTIC s' R`EE
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VERSIDE DgI� WRFy ,'ryOIN J. R.
VERNON L"I ( 6066 i,
Phone No. ( 60)289 f
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and hereby agr�esstate
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one. A11>.WCsrk aha
Windsor standards, al>l OSHA"<::"'<e u'tr"> f " ' arce ith _Own of South
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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: "� L/3 G tc%.r 1
Lot #
Street No. Street Name
Premises owned by: , 1)R¢,'
Name of Firm: _ t. Phone•a� V Sy
Address.of Firm: �l t
, L
Lf�'to
TYPE OF WORK:
Lay House Drain_; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with . 'DR 3!5
Existing Water Supply: Public Water Well
Proposed Start Date 7 L Estimated time for completion lze".d uo
ALL WORK TO BE IN ACCORDANCE WITH TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS CONDITIONS ATTACHED TO THE PERMIT
Permit is to be issued to r the holder of Drain
Layer's License No. c 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.�G
I
. Signed:
Print Name: 5 r^c�,✓
Licensed Drain Layer
Date:_
Standard Forms\Permits\APPUcAIION FOR DRAIN LAYERS PERmrr.doc
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_ DATE
INSPECTEDTOWN STATE ZIP BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR r DEVELOPER