HomeMy WebLinkAboutDrain Layers Permit 803 Dzen Way f
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7470 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 s
Time Insp Needed
Inspected By
Work in Progress
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Perinal:;. lo. 7470 Town of South Windsor, CT
Per-mii--0ate 07/16/2002 Drain Layer Permit
Expiration Date 08/15/2002
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Applicant Location
Name WILCOX CONSTRUCTION C DfIR 440 DZEN WAY
Addr. 535 OLD STAFFORD RO U AN TOWN HOMES
TOLLAND CT '
Phone No. (860)871-1839
The Drain Layer a as cense issued by the
state and hereby agr a th l nd i s set forth in the
attached 'Conditions' 1 r a c with Town of South
Windsor standards, al q ached conditions.
o c
Issued By
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Date Inspected y a �
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: a /��� Lvl-lez Lot #
Street No. Street Name
Premises owned by:
Name of Firm:yin �� �' s/`G�o� � Phone:
Address of Firm: s J— erlcl
TYPE OF WORK:
Lay House Drain_; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with !/
Existing Water Supply: Public Water Well
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 the holder of Drain
Layer's License No. Fd�P' 9. ,�' . 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: Licensed rain Layer Print Name:
r
Date: -7 / ;
OF
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL 'TIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS : Ze-v" a p 0 39�,
STREET c.s/ IA/o•.`,
SUBDIVISION: `
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
S 3 S ato 4K..-.� IRS als-ank
STREET ADDRESS` SIGNATURE .
TOWN STATE ZIP INSPECTED BY TOWN
,�• DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER