HomeMy WebLinkAboutDrain Layers Permit 2799 Ellington Road (2) APPLICATION FOR DRAIN LAYERS PERMIT
TOWN OF SOUTH WINDSOR ! j
PUBLIC WORKS DEPARTMENT ( �
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
Y FEE$25.00
Location of proposed work: 2' Lot #
Street N Street Name
Premises owned by: yl
Name of Firm: Phone:
Address of Firm:
TYPE OF WORK:
LayPRepair House Drain
House Drain Re
Lay Main Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with C�
Proposed Start Date �' _Estimated time for completion t
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 11taL the holder of Drain
layer's License No. Only holders of PI, P7 & 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.
9
Signed: Print Name Licensed Drain Layer
Date: p`Z 7 L
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: -
BUILDING ADDRESS � �
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STREET : �4�
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SUBDIVISION:
NORTH ARROW
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CONTR OR (PRINT) NAME OF NTRACTOR'S SUPERVISOR RINT)
STREET ADD SS SIGNATURE
-JJATE
0 STATE ZIP INSPECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
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TOWN OF `SOUTH WINDSOR INSPECTION REPORT
Permit No. 6788 Contractor ADDIT CONSTRUCTION CO
Location 2799 ELLINGTON ROAD Address 30 PINE HILL STREET
Type Wort; NEW SAN SAT MANCHESTER CT 06040
Rhone" No. ( 860 )872 -91 10
Date I nsp Needed �._. « -Date; Tns
Time Insp Needed Time Inp _ /_G'' =�=1--"- ---
Inspected By ---
Work i r< /L""� ! �"` -- ----- -- -- .
n Progress '
Input '� ` Date ''� c,�
Permit No. 6788 town of South Windsor, CT
Permit Ddte 04/27/ 1993 Drain Layer Permit
E;4pi ' ation Date 05/27/1998
Descrip: SEWER USER PD. RECEIPT #44
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Applicant Location j
Name AUDIT CONSTRUCTION CO Addr . 279.9 EL.L.INGTON ROAD 1
Addr . 30 PINE HILL STREET Owner DOUCETTE LOUIS J JR & CONCETTA
MANCHESTER CT ?8t40
Phone No. ( 860)872-9110
The Drain Layer assigned thl"s permit has a valid license issued by the
state and hereby agrees to all `the terms and conditions set forth in the
attached 'Conditions' . All wui~'k shall ; be in accordIan0e with Town of South .
Windsor standIrds, a 1 1 'OSHA,� r`equ i rements, .and th attached conditions.
Issued By _: � .. .; __: _ T i't 1 e
Date Ins ect d '_. ._ Inspeoteed BY,
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