HomeMy WebLinkAboutDrain Layers Permit 515 Graham Road • .s
TOWN OF SOUTH WINDSOR INSPECTION REPORT
Permit No. 7854 Conf,e--'btox EASTFf,R ` G A ERPROOFING
Location 0515 GRAHAM ROAD50,41"4-1
Type Work RPR SAN LAT
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Permit No. 7854 Town of South Windsor, CT
Permit Date 11/08/2004 Drain Layer Permit
Expiration Date 12/08/2004z
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Applicant %' ✓*
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Name EASTERN WATERPROQ'FI I,G b ?5 1kHAIfi �2E�AD ;.
Addr.. P.O. BOX 504
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SOUTH WINDSOR c"T 0$074.,
Phone No. (860)
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The Drain Layer ssined �s3RP# �} � tiene is�Ised by the
state and hereby agr`:e :r(X a> 1`t,he term an�i �ondi� axz�"'se�`ri£::�,Qxth in the
attached Conditions All on]c hal] zloYds�} ce. vlit'h Tawn of South
Windsor standards, all OSETA `z,0 quixecica'ditions.
Issued Byi,/%� ` ,,TiY 'f_fr� / — -----
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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 $60.00
Location of work: '1� 1��l 6? (�
proposed �%�` Lot #
Street No. Street Name
Premises owned by: �qy1—o 0
Name of Firm: 51.ec ry Phone: ('& L'
Address of Firm:t--) ")-) r o�'AI YV
TYPE OF WORK:
Lay House Drain ; Repair House Drain ;
Lay Main ; Lay Lateral for Commercial/Industrial
Building of acres
Connection will be made with 9 vC-
Existing Water Supply: Public Water Well
Proposed Start Date imated time for completion 01'
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 r � the holder of Drain
Layer's License No. 9. a 15'O 3 9- Only holders of P-1, P-7 or W-9 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: �°'`��
Licensed Drain Layer
. .. Date:
Stafidaed Farms\Pem-dts\APPLICAITON-FOR.DRAIN tAY�RS PERMIT.doC. . .
TOWN OF SOUTH ANDSOR
SANITARY - SEWER LATERAL FIELD LOCATION
DATE OF CONSTRUCTION:
BUILDING ADDRESS I-/S'
STREET
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NORTH ARROW
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CONTRACTOR (PRINT) NAME OF CONTRACTOR'S RVISOR (PRINT)
STREET ADDRESS SIGATURE
DATE
TOWN STATE ZIP IN PECTED BY TOWN
DATE
TELEPHONE NUMBER
WHITE - TOWN PINK - CONTRACTOR YELLOW - CONSULTING ENGINEER / fEVELOPER