HomeMy WebLinkAboutDrain Layers Permit 13 Copper Ridge 750004 TOWN OF SOUTH WINDSOR, CT
-' PERMIT NUMBER DRAIN LAYER PERMIT
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DATE: 04/02/07
3'GIS ID:
FEE: 60.00
MUNIS APPLICATION# 200700350
f' ;k> , y '..;.. -EXPIRATION DATE: 05/02/07
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PLICA
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NAME: `:LOCATION
J&H SLATER CONST>CO E.: E...U ;.:,::' .' <:.IRES,• -- `13•"" OP
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ADDRESS: 75 COMMERCE ' °' `<'_ ;<:. ...;...•_ PEA RIDGE
WAY € .. ;:.. ..,'-.:.KS - EI1COINC
SOUTH WINDSOR
< 1: 1. LLINGTON RD
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PHONE _ ID OR,CT 06074
860-528-�2�2''=
WORK DESCRIPTION: INSTALL'SII'T' �V��`�IP�'I� I �,
THE DRAIN LAYER ASSIGNED TO THIS`P't
1.IA 'A TITEf-SATE AND HEREBY AGREES TO ALL
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THE TERMS AND CONDITIONS SET FORTH III: IIF A. F 1 „, j �•ISt,:: 0 SHALL BE IN ACCORDANCE WITH
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THE TOWN OF SOUTH WIND SOR STANDARI34,ALLOSH: RE'fiN 'AN> : IE ATTACHED CONDITIONS.
ISSUED BY DATE INSPECTED INSPECTED BY
4/2/2007 9:18 AM
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PERMIT NO.: �060 — CONTRACTOR: 5' ck�-�-
LOCATION: f 3 �ni _a� ADDRESS:
TYPE OF WORK:
DATE INSP NEEDED: DATE INSP: g1210 7
INSPECTED BY: 6 q
WORK IN
PROGRESS:
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INPUT: % --` DATE:
' 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: 1 CO??C L (ZI 1) Lot # Z-
Street No. Street Name
Premises owned by: 2S �-- K-e1,cj')
Name of Firm: �:�r ii L- Phone: 'Z�,SZSZ
Address of Firm:
TYPE OF WORK:
Lay House Drain; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with C7Y P-\/C
Existing Water Supply: Public Water k 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 J <5 -mjt, the holder of Drain
Layer's License No. �"�1?b I CqZ . 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 cvd attached thereto. Applicant has received
Town Street Excavation Permit No. and/or ConnDOT Permit No.
CBYD No. �
Signed: / Print Name:
icensed Drain Layer
Date:-
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH - WiNDSOR
4 SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: y '
BUILDING .ADDRESS
STREET X f-
SUBDIVISION:
NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CO RACTOR'S SUPERVISOR (PRINT)
STREET ADDRESS SIGNATURE
.�r�l'`�Y C d (l'75�
TOWN STATE ZIP INSPECTED BY TOWN
?1 0 f-1 k S'�),.t"2 DATE
TELEPHONE- NUMBER.
WHITE - TOWN PINK - CONTRACTOR YELLOW.- :CONSULTING ENGINEER / DEVELOPER