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HomeMy WebLinkAboutDrain Layers Permit 301 Governors Highwa (2) I TOWN OF SOUTH WINDSOR INSPECTION REPORT Permit No, 7786 Cora.traCtor BUTER:.,;COMPANY Location 0301 GOVERNORS HIGHWA Andress -iiNlii 848 MARSHALL PHELPS RD. Type Work DIS SAN LAT W:ZNDSC)R;CT 06095 <:Phon� No (56.9)688-8024.;. Date Insp Needed -------—----- Date �.k}SY .' C1; Time Insp Needed T$me I2'sp i Inspected BY )) oo Work in Progress � t77'LGffG �G � -77 We Sbk 77 Input Date — —�� -- Permit No. 7786 Town of South Windsor, CT Permit Date 08/03/2004 Drain Layer Permit Expiration Date 09/02/2004 Descrip: DISCONNECT 6" SAN LAT Applicant Looat.ion Name BUTLER COMPANY Acld 031 GOVERNORS H;IGHWA Addr. 848 MARSHALL PHELPS RD owner MAY DEQARTMEbTP SC:ORES WINDSOR CT 06095 Phone No. (860)688-8024 The Drain Layer- as* this 7e irsat has a va.I'd license a.ssued by the state and hereby agrees Cc a11:; the"'terms and ctrricli �oin set.:. forth in the attached 'Conditions Al Work ance with Town of South Windsor standards, all OSHA re.quire°i,pt end the attached c;[snditions. Issued By --1-�@.v�--- ----- -- T t 7 e. 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 Location of proposed work: 3 ©f �m��Nm�-� l�l�y Lot # Street No. Street Name Premises owned by: Name of Firm: & Phone: Address.of Firm: 'Y9 �•�� f�GtzpS f�Q (,J�kasD`e C (� TYPE OF WORK: Lay House Drain Repair House Drain ; Lay Main ; Lay Lateraf for Commercial/Industrial Building of acres Connection will be made with Existing Water Supply: Public Water Well Proposed Start Date 'Gf Estimated time for completion S' 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. Only holders of P-1, P-7 or W-9 licenses will be issued a permit. PERMIT WELL 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: &1� � �5��/ Print Name:15og =� -Licensed Drain-La=r Date: 3 Standard Forms\Permits\APPLICATION FOR DRAIN LAYERS PERMIT.doc TOWN OF SOUTH WINDSOR � SANITARY . SEWER LATERAL FIELD LOCATION DATE OF CONSTRUCTION: jr)(Jo BUILDING- ADDRESS. :, 3 c _ 60v e /1"o 15 STREET • :- SUBDIVISION: NORTH ARROW I E t I + •. i f s i � I I t I i t ' s 6 f`yY __. �.__.._.. _ y__ s _.j_. _ ! .__ _ l ! ---------- IVd- y t I - t r I _..__ r I 1 -��' I i � � E i1IL , i i 1�r' f _ 4 RL.Jl ee- crhafA- _ CONTRACTOR (PRINT) NAME OF CONTRACTOR'S SUPERVISOR (PRINT) )OA e STREET ADDRESS" SIGNATURE c ,J�r o q 5 o DATE TOWN— - -' 9 STATE ZIP INSPECTED BY TOWN 2 y DATE TELEPHONE NUMBER WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / DEVELOPER