HomeMy WebLinkAboutDrain Layers Permit 178 Foster Street i
TOWN OF SOUTH WINDSOR INSPECTION REPORT
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Permit No. 7750 Cont_ a:c't'or Aft E'S`-T:'H
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Location 0178 FOSTER STREET jlddress? ::>ri VANS :'SEW.ER`" SEPTIC
Type Work NEV SAN LAT 97 RIVERSIDE D`R:SVE
VFRNON °CT 06,066
/ P:honB N.o ($SO)28"9 0095
Date Insp Needed
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Time Insp Needed Timex; la �
Inspected By
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Date<::
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Permit No. 7750 Town of South Windsor, CT
Permit Date 06/07/2004 Drain Layer Permit
Expiration Date 07/07/2004
Descrip:
Applicant Lpcat :,on
Name DAMES THROWS Adc 0 .78 FOSTER STREET
Addr. VANS SEWER & SEPTIC QC n' �CRAWSKIz. WILZZAM J ::JR & PATRICIA
97 RIVERSIDE DRIVE
VERNON CT.,.06066
Phone No. (860)289-0095 .
The Drain Layer assigned -tYt s per.i t has a va}id license issU by the
state and hereby agrees to ail the terms and conditions set<:: or.;th in the
attached 'Conditions' All work shaT`l � i:f� accordance yYth Town of South
Windsor standards, a11, OSHA r attached ;.eoziditions.
Issued By title -------------------
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
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Location of proposed work: �' r- j
Lot
Street No. Street Name
Premises owned by:
Name of Firm.
.Phone•
Address.of Firm:
TYPE OF WORK:
Lay House Drain Repair House Drain
Lay Main
La '
y Laterar for Commerdai/Industrial
Building .of acres
Connecction will be made with ,
Existing Water Supply: Public Water Well
Proposed Start Date vn) Estimated time for CompletionO .
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 :�"'
Layer's License No. .2�� ��( e holder of Drain
. 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.
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signed: - -.
Print Name: �-
Licensed Drain Layer -
Date: J v
Standard Forms\Permits\APPLl(A ON FOR DRAIN LAYERS PERMrr.doc
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