HomeMy WebLinkAboutDrain Layers Permit 128 Gilbert Lane f
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TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7184 Contractor JACQUES CONSTRUCTION (JOHN)
Location 0128 GILBERT LANE Address 67 RIDGE ROAD
Type Work NEW SAN LAT SOUTH WINDSOR CT 06074
Phot e, No. (860)432-1823 �
Date Insp Needed ,Qate Ins, 9Ln 112a
Time Insp Needed Insp. = 9�00
Inspected By
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Work in Progress
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Iynput Date
Permit No. 7184
Town of South Windsor, CT
Permit, Date 09/08/2000 Drain Layer Permit
_Expiration Date 10/08/2000
De$crip:
Applicant Location
Name JACQUES CONSTRUCTION (40HIN) Adctr, 01,28 GILBERT LANE
Add,r. 67 RIDGE ROAD Owner tLARK REALTY INC
SOUTH WINDSOR CT
Phone No. (860)'432-1823 _ .
i=� t� s r t$t :. as,
a i ! "1-i cense issued by the
The Drain Layer aoW
state and hereby agrees I thlil-t1dr set forth in the
attached 'Conditions " AI `,Work s ; yin aop_ , nge -with Town of South
Windsor standard a l l ''OSHA; reg9 r rand th$ atlached conditions .
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Issued B
Date Inspect d ��1��� � SnspeCiaed By
APPLICATION FOR DRAIN LAYER PERMIT B
TOWN OF SOUTH WINDSOR r7 f4
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
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Location of proposed work:_ `1�j}�„r Ltl Lot #
street o. Street Name
Premises owned by: Ohl Q
Name of Firm: Phone: -/LYE
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 JAR 3 S—
Existing Water Supply: Public Water
I 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 T v 'p—S the holder of Drain
Layer's License No. -30 S T 2 . Only holders of P1 or P7 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.
Signed: Print Name: JDA n �e S
Li ed in Layer
Da �
Standarls\per�
mits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
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TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: 9 /?/,�'o
BUILDING ADDRESS : /� ��,/A ,-->r f --AI
STREET : KI 11 --e/,--/ 'Z_ �V7 '
-I- SUBDIVISION: deez, 144 ' ZZ ! �_f
NORTH ARROW 5 -efib(fr '
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CONTRACTOR (PRINT) NAME 0 CONTRACTOR'S UPERVISOR (PRINT)
S REET ADDRES ATURE
l� 4.e C Ao7 q ! d� DATE
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TOWN STATE ZIP INSP ED 11Y TOWN
DATE
TELE HONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER