HomeMy WebLinkAboutDrain Layers Permit Eagle Run - Sewer Ma I
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7747 Cont;rac'tor SIMSCRO:F:T ECHO FARMS
Location EAGLE RUN ELDERLY HOUSING :Address:: '`te`> P.O; ::.B.pX 53:,,
Type Work SAN MAIN S. P4SBURY Cfi 06'D::70
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Permit No. 7747 Town of South Windsor, CT
Permit Date OS/26/2004 Drain Layer Permit
Expiration Date 06/25/2004
Descrip: INSTALL SEWER MAIN EXTENSION
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Applicant
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Name SIMSCROFT ECHO FARMS �dALE RUNLbERL]'; HOUSING
Addr. P.O. BOX 581 Owri�r,..
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SIMSBURY CT_06070
Phone No. (860)651-0231-.
The Drain Layer aszgre� Y2is Prmi has alid Ticense issued by the
state and hereby agiees to aI the "terms 'and conditons set,:forth in the '
attached 'Conditions' "A'l1 wdk sha:l` acoxdance faith Town of South
Windsor standards, a17 OSHA:requirement; .grids atta"ched.,,coaiditions.
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Date Inspected
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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 $60.00
Location of proposed work: Qdj
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Street No. Street Name
Premises owned by:_b-ah �,-Y
Name of Firm; Phone: �d-65 - 7e
Address.of Firm:
?YPE OF WORK:
Lay House Drainer Repair House Drain ;
Lay Main - Lay Lateral for Commercial/Industrial
Building of_acres .
Connection will be made with g PVC
Existing Water Supply: Public Water V Well
Proposed Start Date_,,'_*"-, Estimated time for completion
ALL WORK-TO BE IN ACCORDANCE WITH*TOWN OF SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permit-is to be Issued to `2 I the holder of Drain
Layer's License No. Only holders of P-1, P-7 or W-9 licenses
will be,issued a permit PERMIT WILL EXPIRE THIRTY(30)'DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer hereby agrees to all the terms
and conditions set forth In the permit and attached thereto.' Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD NO.
Signed: Print Name:�p nr�e/ T > �•`� v�
Licensed Drain Layer
Date:, ` 21a - `lay
FOR DRAIN LAYERS PERMIT.doc
Standard Forms\Permit$\APPL1CAJ10N