HomeMy WebLinkAboutDrain Layers Permit 202 Strawberry Lane n TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No Contractor WILCOX CONSTRUCTION CO(DARRYL)
Location : ,_ . -LN' Address 535 OLD STAFFORD ROAD
Type Work NEW SAN LAT TOLLAND CT 06084
a No. (860)871-1839
Date Insp Needed s 3 s
Time Insp Needed
Inspected By
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Date
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r No. 7613 Town of South Windsor, CT
Pit Date 03/11/2003 Receipt - Drain Layer
E Date 04/10/2003
Descrip: CK 8429 3 LOTS PERMIT FEE S.U. PD ON CONN
Name : WILCOX CONSTRUCTION CO( R )
Property Address 202 STRAW
BE n 40 Agreement N Type CK 8429
User Type RESIDENTIAL eas ced , y lapien {
P/R User Fee
Connection Charge .Paid
Permit Fee Paid
Total Paid
Tendered:CK 8429
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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: #
Street No. Street Name
Premises owned by:-, -S'
Name of Firm: ea Phone:°
Address of Firnay-� z �✓
TYPE OF WORK:
Lay House Drain epair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres -
-1(
Connection will be made with
Existing Water Supply: Public Water Well
Proposed Start Date..Z`/1 1�),7 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/�6 �� /� /�` �f' the older of Drain
Layer's License No. _ 'o�bf�� Only holders of P1 or licenses will be
issued apermit. 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 kas received Town
Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No.
Signed• Print Name:/�i.:f-/W-'
Licensed Drain Layer
Date:,.zz///�--/
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrr.doc
TOWN- OF SOUTH WINDSOR
SANITARY*;. SEWER LATERAL FIELD LOCATION
DATE OF-CONSTRUCTION:
BUILDING -
BUILDING ADDRESS k. 2
STREET" : ViLJ ;. L 14/
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR.(PRINT) -
5 3
STREET ADDRESS SIGNATURE
DATE
311316
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW = CONSULTING ENGINEER / DEVELOPER