HomeMy WebLinkAboutDrain Layers Permit 104 Gilbert Lane ti
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7361 Contractor JACQUES CONSTRUCTION (JOHN)
Location '3ILBERT LANE Address 67 RIDGE ROAD
Type Work NEW SAN LAT SOUTH WINDSOR CT 06074
Phone No. (860)432-1823
Date I nsp Needed ;D te I n'sp. ,i% U U I _
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Time Insp Needed Tm4flnsP•
Inspected B
Work" i n Progress
Q, Input Cam' Date
Pe "m tt No. 7361 'Town of South Windsor, CT
Per-f-it Bate 11/29/2001 Drain Layer Permit
Expiration Date 12/29/2001
Descripv., 11217 $875.00 CK11218 $136. 68
Applicant Location
Name JACQUES CONSTRUCTION (J4-tN} Addi^. �0 1Q4 GILBERT LANE
Addr. 67 RIDGE ROAD Qwne"'—LARK REALTY INC
SOUTH WINDSOR CT 46074
Phone No. (860 )432-1823 `
The Drain Layer asi,gnd_ this perm -ha"s u 11 a1 zd 1 i.:cense issued by the
state and hereby agreos �t€z 't I°� th m end oon i t,ic r s set forth in the
attached 'Conditions"*' k sha��1 . 5 ; -fn aocr}riafice with Town of South
Windsor standards, all °.OS i;s. .and ti attached conditions.
Issued BY _�
Date Inspected �� _ �� inspected BY
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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: Za�z x�"'Ae1'4/jn Lot #
Street No. Street Name
Premises owned by:� ,,� �STD
Name of firm: Phone: '
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 S 3S
Existing Water Supply: Public Water Well
Proposed Start Date Ui Estimated time for completion bv�
ALL WORK TO BE IN ACCORDANCE WITH TOWN Of SOUTH WINDSOR STANDARDS,
ALL OSHA REQUIREMENTS.AND CONDITIONLATTACHED TO THE PERMIT
Permit is to be issued to Jf a�s' � the holder of Drain
Layer's License No. -T.SD, my holders of P1 or P7 licenses will be
issued a permit. PERMIT WILL EXPIR 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.
Signed: Print Name: ---
Lrcens ra' �Ler
- _ -
Date:
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Standard Fo ms\Per its�APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: r ' -,
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CONTRACTOR (PRINT) NAME F CONTRACTOR' SU ERVISOR (PRINT)
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STREET ADDRESS GNATURE
G/ Q 6 7 l/ �a a / DATE
TOWN STATE ZIP T— INSPECTED BY TOWN
DATE
TELEPH NE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 7-/;4 -0 a
BUILDING ADDRESS
STREET
SUBDIVISION: Al r,.f
NORTH ARROW
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CONTRACTOR (PRINT) NAME Or CONTRACTOR'S SUPERVISOR (PRINT)
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STREET ADDRESS SIGNATUR
Lp� -4 ti/>� /,PG"-- ('�- OG U 7 Y DATE
TOWN STATE ZIP INSPECTED BY TOWN
H Q DATE
TELEPHONE NUMBER
WHITE — TOWN PINK — CONTRACTOR YELLOW — CONSULTING ENGINEER / DEVELOPER