HomeMy WebLinkAboutDrain Layers Permit 67 Eagle Run TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 7818 COIJ, actor tWILCgX "K1-QHAEL (EAGLE)
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Type Work NEW SAN LATlk?AD
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Permit No. 7818 Town of South Windsor, CT
Permit Date 09/14/2004 Drain Layer Permit
Expiration Date 10/14/2004
INSTALL r.'
Descrip: SANIT. LAT :�%`'�,;.
Applicant „"F: s' :ws:
1 f La on
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Name WILCOX, MICHAEL
Addr. EAGLE EARTHWORK §ERV ' c, ier MANNARTO aI1DERS INC
101 N MOUNTAIN
CANTON G£ 0&aI9
3 M-
Phone No. (860)693-20'27
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The Drain Layer asin �lby s ":> h s
state and hereby agree0t6he` erm°s'Y`an3 coton .;..sk;.:for.Ch in the
attached 'Condition—' .""Rill wck �3h �ei t� dane 41 th Torn of South
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Windsor standards, alb OSIJAuir�m�sZie attaceci conditions.
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Issued BY
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«ate,
Date Inspected ....................
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SUUJVAN AVENUE
SOUTH WINDSOR, CT
FEE $60.00
Location of proposed work: 60'� v
Lot-#-_
Street No. Street Name
Premises owned by: OfA
�l�dl
Name of firm;
v Phone: L v*�r
Address:of Firm: n,
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TYPE OF WORK: r
Lay House Drain Repair House Drain
Lay Main . Lay Lateran for Commercial/IndustrialBuilding of acres
Connection will be made with �t�ye
Existing Water Supply: Pubiic.Water . Well
Proposed Start Date _ Estimated time for comP letion
ALL WORKTO.BE IN ACCORDANCE WITH'TOWN OF SOUTH WINDSOR STANDARDS
ALL.OSHA REQUIREMENTS AND CONDITIONS ATTACHED TO THE PERMIT
Permitis to be issued to
Layer's License No. the holder of Drain .
will be issued a On ��ofP-1; P-7 or W.9 licenses
petmtt. PERMIT WILL EXPIRE THIRTY(30)DAYS AFTER
DATE OF ISSUANCE. The undersigned Drain Layer.hereby agrees to all the teens
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:j
Print Name:_
Licensed Drain Layer
Date:
standard F0rms\Perm1tAWLZCAT10N FOR DRAIN LAYERS PERMIT.doe
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TOWN OF SOUTH ANDSOR
SANITARY - SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: �� ' Zoo y
BUILDING ADDRESS 1 y
STREET : F—A G LE QAJ
—�— SUBDIVISION:
NORTH ARROW
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to
3 M
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