HomeMy WebLinkAboutDrain Layers Permit 28 Gilbert Lane Perrhit No. 7040 Contractor JMJ CONSTRUCTION CO.
Location 0028 GILBERT LANE Address 658 ELLINGTON ROAD
Type Work NEW SAN LAT SOUTH WINDSOR CT 06074
Phone No. (860)528-7889 i1
Date Insp Needed InAl CA17 Dam Insp. ���7/ 9 9 j
Time Insp Needed .4• �"c 17ime 'Insp-;a A � -
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Input4 Date
Permit No. 7040 Town of South Windsor, CT
Layer a -m ---
x iraeion Date 09/22/1999
drip: USER FEE PAID CK#09268 I
Location
Applicant
Name JMJ CONSTRUCTION CO. Addr. 0028 GILBERT LANE
Addr. 658 EL.L-INGTON ROAD Owner CLARK REALTY INC
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SOUTH WINDSOR CT 06074 ,
Phone No. (860)528-7889
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The Drain Layer ,asgi grr°e� ht`s pe"nit'iras"fit 'field ,license issued by the
state and hereby agree >` } r1 and COCtC 1 ti Ckns set forth in the
attached 'Conditions' .. 1`� ws�t�l si ) i n';' cr'drrc with Town of South
Windsor standards, all `®$HA} r 4u"1rr�m ►rat > and" tie, attached conditions.
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Issued By
Date Inspected �Z7�9
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS LOB ) 7
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STREET . � G� n �
SUBDIVISION: M ► C., 1S
NORTH ARROW
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CONTRACTOR (PRINT) NAWF-CONTTOR'S UPERV OR (PRINT)
,'h R STREET ADDRESS SIG
�1/ '1 1� C. �7 DATE
-TOWN // STATE ZIP INSPECTED BY OWN
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D,g� ()b� g DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT-
FEE $25.00
Location of proposed work: 6 1 �er Lot #—JZ
Street No. Street Nrame
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- Premises owned by: �I �r Y C t
Name of Firm: --------- "
Phone:
Address of Firm: h 5'9 !E( ,
TYPE OF WORK:
Lay House Drain ; Repair House Drain
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with E
Proposed Start Date Estimated time for completion 1 *
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 1740 leS -Tcnms .;the holder of Drain
Layer's License No. On holders of P1, P7 &W9 licenses will
be issued a.permit. Permit will expire thirty (3-0) 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.
Signed: Print Name: �� (.���S
Li se rain Layer
Date:
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMrr.doc