HomeMy WebLinkAboutDrain Layers Permit 45 Good Hill Road TOWM' ,')F ( ("UTH W,(NDSOR INSPECTION -01-POIRT
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Permit NO. -intractor GERRER (,OM6TRUCl
Locati on 0045 COCAD, HT.Li... Aclorpss 616 DART hTLL RoA0
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Permit, No. 31 Q ij c h w, i so r
Perm-# f. Date () 1 /002 j_200 I Or-aln, !_ayer P--- NTJIL
Exp'i ration Date 0'42/021"_4,l(j1
Descrio:
Applicant LOC-at i on
Name GERBER CONSTRUJI"'! ION Gl(a Ad d r. 0045 GOOD HJI'LL ROAD
Addr. 616 DART HILL RC)AD Dwner GRIMALDI NAP4UY C
VERNON GT U6(.jf&'6';
Phone No.
The Drain Laver, ass i g-ned th s permi t has -3 yalid 1 -1cense 1 ,13suea by the
to
, al the ter end condiTions set forth -in the;state and herebv agree:
attached 'Cond it, i on8� Al V work shal I be n accor()ance witri Town of �:)Outn
Windsor stanaards , a I OSHA requirements, and the attached cone it' ion8.
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APPLICATION FOR DRAIN LAYER PERMIT
TOWN OF SOUTH WINDSOR ? Z33
PUBLIC WORKS DEPARTMENT
TOWN HALL
1540 SULLIVAN AVENUE
SOUTH WINDSOR, CT
FEE $25.00
Location of proposed work: 7 ( 1��c �(` (I��l Lot #
Street No. Street Name
Premises owned rr'
Name of Firm: ( r r� C Phone: cfpf
Address of Firm: a114 kr wljv( Jo
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 Well
Proposed Start Date / S` o 5 0
p 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 (— the holder of Drain
Layer's License No. P9 yS2 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: S ��
Licensed Drain Layer
Date: e/— ; di
Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc
TOWN OF SOUTH WINDSOR
SANITARY SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION: - dl
BUILDING ADDRESS ``S
STREET
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT)
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STREET/ADDRESS SIGNATURE
I/ i2�vaf✓ C 7- d60 ���� �� �c9/ DATE
TOWN STATE ZIP INSPECTED BY TOWN
8,6-0 _6 DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER
TOWN OF SOUTH WINDSOR INSPECTION REPORT
PROJECT: 0 72,33 DEVELOPER
STREET- �s- Cow
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DATE: ��.e��Y� C'o.vsr✓zv��-edN �b
4/ TIME: oyo 9�1 iv 3 00
WEATHER:
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WORK IN PROGRESS:
AREA OF CONCERN:
SPECIAL INSTRUCTIONS:
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