HomeMy WebLinkAboutDrain Layers Permit 603 Dzen Way TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 743Q, _ Contractor WILCOX CONSTRUCTION CO(DARRYL)
Location Address 535 OLD STAFFORD ROAD
Type Work NEW SAN LAT TOLLAND CT 06084
No. (860)871-1839
Date Insp Needed
Time Insp Needed
Inspected By �
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Work in Progress
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Per t�N?. 7430 Town of South Windsor, CT
Permit Rate 05/15/2002
Drain Layer Permit
Expfration Date 06/14/2002
Descrip: UNIT 13
Applicant Location
Name WILCOX CONSTRUCTION C r. DZEN WAY
Addr. 535 OLD STAFFORD ROA
TOLLAND CT 1
Phone No. (860)871-1839
The Drain Layer a s s as c cense issued .by the
state and hereby agr e " nd io s set forth in the
attached 'Conditions' . 1 r a with Town of South
Windsor standards, al q ' ached conditions.
Issued By
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Date Inspected J l5 �Z y DNA
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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 $2500
Location of proposed work: Lot #
Street No. Street Nafne
Premises owned by:
Name of Firm:/-/,// Phone: ezl�-�
Address of Firm:
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
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 A= f.C1s1ec-r the holder of Drain
Layer's License No. .2 o_1E Only holders of P1,&!'�'&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: o!!� Print Name:
Licens d Drain Layer
Date: . �������2—
Standard Forms\Perrmits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERALTIELD LOCATION
DATE OF CONSTRUCTION:
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER