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HomeMy WebLinkAboutDrain Layers Permit 30 Copper Ridge 750005 TOWN OF SOUTH WINDSOR, CT . PERMIT NUMBER DRAIN LAYER PERMIT ., DATE: 04/02/07 '` GIS ID:23500030 FEE: 60.00 MUNIS APPLICATION 4 200700353 _ 3> :`: .`': `.:;f:: °> EXPIRATION DATE: 05/02/07 : .e �: :.: N'�F' >: oi: APPLICANT, z xf . OCATION NAME: J&H SLATER CONSTf;CO :; nm A I PPE RIDGE ;:: LI: O INC ADDRESS: 75 COMMERCE WAY:<` 5Ru ::':>'` S -I C `> GTON RD SOUTH WINDSOR CT a6Q714>;�",. J ,•������ ;::::;:': i=><1::�... .��LIN. H::;::': TSOR T 06074 % - �25 2� ' PHONE 86028-5 /F.. WORK DESCRIPTION: INSTALL`�V, yl.Te :':>:. :. V >I✓ '� RA ' ,f. .:,; ":��:�:..r THE DRAIN LAYER ASSIGNED TO THIS P T Ff. p U'> `SUEL '$.1'THL STATE AND HEREBY AGREES TO ALL THE TERMS AND CONDITIONS SET FORTITIE. t ( 5';::rI i` .fo,"I SHALL BE IN ACCORDANCE WITH THE TOWN OF SOUTH WINDSOR STANDA I' �IIt .Itf1 ,:`AI�ID'i'IE;ATTACHED CONDITIONS.Rl3 - rPJ A ` ISSUED BY DA E INSPECTED INSPECTED BY 4/2/2007 9:55 AM TOWN OF SOUTH WINDSOR INSPECTION REPORT PERMIT NO.: 7 - 00 05— CONTRACTOR: 1 H s LOCATION: ADDRESS: TYPE OF WORK: DATE INSP NEEDED: DATE INSP: L( 3 0 INSPECTED BY: 8 A WORK IN PROGRESS: S PvC S I1rz, 3 S Fromm-, -1-r111'►O �0 t vn"1' VY k-e S� -e.G n v�t F��.�.A 't�6 `�� ,/-, l� U�. Ecl+ G 6 iv. 3��/r cf tf S d 3SZ INPUT: DATE: �' . 0 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: '5b 196E Lot #�_ Street No. Street Name Premises owned by: Name of Firm: AA Phone: Address of Firm: 1� CUP f A 1� Cl AI TYPE OF WORK: . Lay House Drain_; Repair House Drain ; Lay Main ; Lay Lateral for Commercial/Industrial Building of acres Connection will be made with Existing Water Supply: Public Water. X Well Proposed Start Date ' ©Z 6 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. Sf-A�l�-- the holder of Drain Layer's License No. -ZO 3�6 . 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. 111 and/or ConnDOT Permit No. CBYD No.. 130 icglz— 1 � Signed: Print Name:_ _ 5LATC -ensed Drain Layer Date: 3/ 67 Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc TOWN OF SOUTH YINDSOR SANITARY SEWER LATERAL[ FIELD , LOCATION DATE OF CONSTRUCTION: ' O 7 BUILDING ADDRESS : 3. o : (-,44eo o- t� STREET • .- D ,��/� T SUBDIVISION: NORTH ARROW 4 .. 6 . _ _ CONTRACTOR (PRINT) NAME OF CO RACTOR'S SUPERVISOR (PRINT) STREET ADDRESS. SIGNATURE Jrl i0 dJ c�- Oe 7`/ 9 YA DATE TOWN STATE ZIP INSPECTED BY TOWN DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW CONSULTING ENGINEER / DEVELOPER