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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7429 Contractor WILCOX CONSTRUCTION CO(DARRYL)
Location Address 535 OLD STAFFORD ROAD
Type Work NEW SAN LATe TOLLAND CT 06084 1
ee No. (860)871-1839
Date Insp Needed s 5 (S OrL
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Time Insp Needed
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Permit.; No. 7429 Town of South Windsor, CT
Perrfit Date 05/15/2002 Drain Layer Permit
Expiration Date 06/14/2002
Descrip: UNIT 12
Applicant Location
Name WILCOX CONSTRUCTION C D 0 DZEN WAY
Addr. 535 OLD STAFFORD ROA
TOLLAND CT .
Phone No. (860)871-1839
The Drain fj Layer a sq s as cense issued by the
state and hereby agr es--4 a nd io s set forth in the
attached 'Conditions' .Al r a with Town of South
Windsor standards, al q ached conditions.
Issued By °r
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Date Inspected y � ?EA
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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: Lot #
Street No. Street f4ame
Premises owned haw/y
Name of Firm: C10 Z Y o' Phone:
Address of Firm:S�J
TYPE OF WORK:
Lay House Drain l/ ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with ey
Proposed Start Date / e> 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 th holder of Drain
Layer's License No. q Only holders of P1,X W9 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.
Signed: - Print Name:/������
licensed Drain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS Z�c-v le-"
STREET : N
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CONTRACTOR (PRINT) NAME OF CONTRACTORS SUPERVISOR (PRINT)
STREET ADDRESS / L SIGNATURE
DATE
TOWN p STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER