HomeMy WebLinkAboutDrain Layers Permit 12 Eagle Run y TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7898 qiohtr ctjp�. WIL OX 14ZHAEL (EAGLE)
Location 0012 EAGLE RUN A .ce:SS AGIEkAHWCR SERV.
Type Work NEW SAN LAT "`kA' "
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Permit No. 7898 '>%>%'»><:;;:,, Town of South Windsor, CT
Permit Date 04/06/2005 '" Q.,."L`". Drain Layer Permit
Expiration Date 05/06/2005
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Name WILCOX, MICHAELy' (` A I&') - >� r.� 0'12�- }I-GL'EfL,RON'
Addr. EAGLE EARTHWOR SE�2V °f $ � ci� AN �IQ i3#JILDERS INC
101 N MOUNTAIN; RY3AD
CANTON >CT. 6.
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Phone No. (860 693- .
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state and hereby ague. s:t`p: :al;l';.`. kze:;; :"' a33ati{� ?taS`xl. ;'st"<fs3rth in the
attached 'Conditions! . All'<:,Wo if < : a" ^%: . ; ' ''' : :c�r'tT'arj: e/w tt� [own of South
lqu
Windsor standards, al`1 018.L3A`'xe' i: ` ` .Y} 3�e conditions.
Issued By t,..:e:. ``..
Date Inspected --------------------- Inspected By ----------- ---
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: L' +01-.t 4 Lot # Z
Street No. reet Name
Premises owned by: 01"A
Name of Firm: Phone:_(0ZE,'1Z7.
Address.of Firm:_/ 1)A&A
TYPE OF WORK:
Lay House Drain_; Repair House Drain ;
Lay Main ; Lay Lateral-for Commercial/Industrial
Building of acres
Connection will be made with o` V�
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 c A e'l DV.- the holder of Dr
ain
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.
r
SignG R,19 Print Name:
Licensed Drain La r
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN - OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: `— 7 v
BUILDING ADDRESS l j
STREET
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SUBDIV
ISION: k� e Le,
NO ARROW
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C R (PRINT) NAME 0 C NTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS/ L SIG TUR /
Cyr�% 'Z24 7 t Z�L t z4 11117
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER
TOWN OF 'OUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: �^> �° e 2 co"1 --
BUILDING ADDRESS Lc i . Z
STREET
-�- SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
DATE
TOWN STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER